Provider Demographics
NPI:1679871685
Name:BRADBURY, LORI A (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:BRADBURY
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 1:9720 LEHMAN RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47471
Mailing Address - Country:US
Mailing Address - Phone:309-287-9431
Mailing Address - Fax:
Practice Address - Street 1:1014 MILL POND LANE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-653-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004711A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist