Provider Demographics
NPI:1013495308
Name:SMITH, BRADLEY GENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:GENE
Last Name:SMITH
Suffix:
Gender:M
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 1:3410 WORTH ST STE 760
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2005
Mailing Address - Country:US
Mailing Address - Phone:214-818-7948
Mailing Address - Fax:214-818-8237
Practice Address - Street 1:3410 WORTH ST STE 760
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2005
Practice Address - Country:US
Practice Address - Phone:214-818-7948
Practice Address - Fax:214-818-8237
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist