Provider Demographics
NPI:1679092431
Name:STRIBLING, BRAD JAMES
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:JAMES
Last Name:STRIBLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3811
Mailing Address - Country:US
Mailing Address - Phone:309-743-1612
Mailing Address - Fax:
Practice Address - Street 1:1015 16TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3811
Practice Address - Country:US
Practice Address - Phone:309-743-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist