MEDICARE: SONJA BRADFORD, MS CCC-SLP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL00002871	WA

General Provider Information

NPI Number	:	1942442280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONJA BRADFORD, MS CCC-SLP, PLLC

Provider Business Mailing Address
First Line	:	9725 SE 36TH ST.
Second Line	:	SUITE 205
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-232-2046
Fax Number	:

Provider Business Practice Location Address
First Line	:	9725 SE 36TH ST
Second Line	:	SUITE 205
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3841
Country	:	US
Telephone Number	:	206-232-2046
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	SONJA BRADFORD
Credential	:	M.S. CCC-SLP
Telephone Number	:	206-232-2046

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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