Provider Demographics
NPI:1508309022
Name:BRADSHAW, KRISTEN LEE NELSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE NELSON
Last Name:BRADSHAW
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 1:4010 SANDY BROOK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1518
Mailing Address - Country:US
Mailing Address - Phone:512-388-8904
Mailing Address - Fax:
Practice Address - Street 1:4010 SANDY BROOK DR STE 201
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1518
Practice Address - Country:US
Practice Address - Phone:512-388-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist