Provider Demographics
NPI:1013257641
Name:BRADLEY, STEPHANIE SUZANNE (AUD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3660
Mailing Address - Country:US
Mailing Address - Phone:304-914-4423
Mailing Address - Fax:
Practice Address - Street 1:2436 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3660
Practice Address - Country:US
Practice Address - Phone:304-914-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006282231H00000X
WVA-0294231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist