Provider Demographics
NPI:1679817456
Name:BRADFORD, KIMBERLY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GARDEN STREET
Mailing Address - Street 2:APT 2A
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3700
Mailing Address - Country:US
Mailing Address - Phone:631-678-7152
Mailing Address - Fax:
Practice Address - Street 1:80 EAST END AVENUE
Practice Address - Street 2:CLARKE SCHOOL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-585-3500
Practice Address - Fax:212-585-3300
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist