Provider Demographics
NPI:1497960553
Name:BRADLEY, HENRIETTA FRAZIER (SP)
Entity Type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:FRAZIER
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-0181
Mailing Address - Country:US
Mailing Address - Phone:318-878-5813
Mailing Address - Fax:
Practice Address - Street 1:240 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2008
Practice Address - Country:US
Practice Address - Phone:318-878-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA87235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist