Provider Demographics
NPI:1760633838
Name:BRADFORD, MICHELE MANLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MANLEY
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3107
Mailing Address - Country:US
Mailing Address - Phone:541-969-1175
Mailing Address - Fax:
Practice Address - Street 1:604 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3107
Practice Address - Country:US
Practice Address - Phone:541-969-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist