Provider Demographics
NPI:1659665206
Name:BRADLEY, ASHLEY IRVIN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:IRVIN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WOODSONG DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-9783
Mailing Address - Country:US
Mailing Address - Phone:864-431-1565
Mailing Address - Fax:864-578-3544
Practice Address - Street 1:334 WOODSONG DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-9783
Practice Address - Country:US
Practice Address - Phone:864-431-1565
Practice Address - Fax:864-578-3544
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist