Provider Demographics
NPI:1427378405
Name:BRADLEY, FAITH RAULETTE (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:RAULETTE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 LIVELY STONE RD
Mailing Address - Street 2:
Mailing Address - City:ISLANDTON
Mailing Address - State:SC
Mailing Address - Zip Code:29929-3208
Mailing Address - Country:US
Mailing Address - Phone:843-295-8368
Mailing Address - Fax:
Practice Address - Street 1:1312 LIVELY STONE RD
Practice Address - Street 2:
Practice Address - City:ISLANDTON
Practice Address - State:SC
Practice Address - Zip Code:29929-3208
Practice Address - Country:US
Practice Address - Phone:843-295-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist