Provider Demographics
NPI:1477156057
Name:BRADBURY HARRIS, EMILY RUTH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:BRADBURY HARRIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6439
Mailing Address - Country:US
Mailing Address - Phone:979-219-3917
Mailing Address - Fax:
Practice Address - Street 1:7915 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-6439
Practice Address - Country:US
Practice Address - Phone:979-219-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist