Provider Demographics
NPI:1881941946
Name:BRADLEY, DONNA M (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:F
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 1:327 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1107
Mailing Address - Country:US
Mailing Address - Phone:914-774-8599
Mailing Address - Fax:
Practice Address - Street 1:327 KELLY ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1107
Practice Address - Country:US
Practice Address - Phone:914-774-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022179OtherSTATE LICENSE