Provider Demographics
NPI:1508015256
Name:BRADBURN, JULIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRADBURN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-7732
Mailing Address - Country:US
Mailing Address - Phone:770-355-6366
Mailing Address - Fax:
Practice Address - Street 1:740 MIDDLE CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-446-9750
Practice Address - Fax:865-446-9751
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004509235Z00000X
AR4060235Z00000X
TN5921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist