Provider Demographics
NPI:1760993166
Name:BRADFORD, JESSICA TAYLER (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:TAYLER
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6829
Mailing Address - Country:US
Mailing Address - Phone:928-287-1296
Mailing Address - Fax:
Practice Address - Street 1:2662 S 25TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6829
Practice Address - Country:US
Practice Address - Phone:928-287-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA108802355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA10880OtherAZ SLPA LICENSE