Provider Demographics
NPI:1356910483
Name:BRADFORD, MARISSA ANN
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ANN
Other - Last Name:SKWIERCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8128 CANNON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-1111
Mailing Address - Country:US
Mailing Address - Phone:716-698-2416
Mailing Address - Fax:
Practice Address - Street 1:1735 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2603
Practice Address - Country:US
Practice Address - Phone:832-384-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81076237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist