Provider Demographics
NPI:1629739560
Name:BRADLEY, ASPEN JOLANIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASPEN
Middle Name:JOLANIE
Last Name:BRADLEY
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 1:5730 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1533
Mailing Address - Country:US
Mailing Address - Phone:580-927-6492
Mailing Address - Fax:
Practice Address - Street 1:4005 NW EXPRESSWAY STE 605
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8600
Practice Address - Country:US
Practice Address - Phone:405-722-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist