Provider Demographics
NPI:1932502960
Name:BRADLEY, KRISTINA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BRADLEY
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 1:1 COURAGEOUS CT
Mailing Address - Street 2:UNIT 510
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6665
Mailing Address - Country:US
Mailing Address - Phone:850-544-4310
Mailing Address - Fax:
Practice Address - Street 1:1 COURAGEOUS CT
Practice Address - Street 2:UNIT 510
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-6665
Practice Address - Country:US
Practice Address - Phone:850-544-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist