Provider Demographics
NPI:1255749495
Name:RIVES, BRADY BOSTICK (AUD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:BOSTICK
Last Name:RIVES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6538
Mailing Address - Country:US
Mailing Address - Phone:334-872-9711
Mailing Address - Fax:334-874-7574
Practice Address - Street 1:4 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6538
Practice Address - Country:US
Practice Address - Phone:334-872-9711
Practice Address - Fax:334-874-7574
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1127A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist