Provider Demographics
NPI:1942615554
Name:BRADSHAW, KIRSTIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:BRADSHAW
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 1:280 D ROUTE 130
Mailing Address - Street 2:SUITE 7 HERITAGE PARK PLAZA
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2363
Mailing Address - Country:US
Mailing Address - Phone:509-833-1060
Mailing Address - Fax:
Practice Address - Street 1:280 D ROUTE 130
Practice Address - Street 2:SUITE 7 HERITAGE PARK PLAZA
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2363
Practice Address - Country:US
Practice Address - Phone:509-833-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist