Basic Information
| Provider Information | |||||||||
| NPI: | 1457485393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 VIOLA ROAD | ||||||||
| Address2: | P.O.BOX 429 | ||||||||
| City: | NORTH EASTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026510429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747220840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ALDEN ST | ||||||||
| Address2: | |||||||||
| City: | PROVINCETOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026571456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747220840 | ||||||||
| FaxNumber: | 5084877706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 06/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1923 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.