Provider Demographics
NPI:1942442280
Name:SONJA BRADFORD, MS CCC-SLP, PLLC
Entity Type:Organization
Organization Name:SONJA BRADFORD, MS CCC-SLP, PLLC
Other - Org Name:MERCER ISLAND SPEECH PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:206-232-2046
Mailing Address - Street 1:9725 SE 36TH ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-232-2046
Mailing Address - Fax:
Practice Address - Street 1:9725 SE 36TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3841
Practice Address - Country:US
Practice Address - Phone:206-232-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty