Provider Demographics
NPI:1598953226
Name:BRADSHAW, ADINA L (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:L
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 CREEKSIDE VILLAGE DR NW
Mailing Address - Street 2:SUITE 602
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2394
Mailing Address - Country:US
Mailing Address - Phone:678-521-4692
Mailing Address - Fax:866-384-6451
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW
Practice Address - Street 2:SUITE 602
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2394
Practice Address - Country:US
Practice Address - Phone:678-521-4692
Practice Address - Fax:866-384-6451
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist