Provider Demographics
NPI:1023662053
Name:BRADSHAW, CARSON SHAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARSON
Middle Name:SHAE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:SHAE
Other - Last Name:BARBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0446
Mailing Address - Country:US
Mailing Address - Phone:704-438-8303
Mailing Address - Fax:
Practice Address - Street 1:124 E NORTH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4048
Practice Address - Country:US
Practice Address - Phone:704-438-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist