Provider Demographics
NPI:1669448916
Name:BRADLEY, STUART M (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:M
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 1:408 BRIERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4239
Mailing Address - Country:US
Mailing Address - Phone:919-302-2990
Mailing Address - Fax:919-342-4613
Practice Address - Street 1:408 BRIERRIDGE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4239
Practice Address - Country:US
Practice Address - Phone:919-302-2990
Practice Address - Fax:919-342-4613
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist