Healthcare Provider Details

I. General information

NPI: 1376647479
Provider Name (Legal Business Name): BRADLEY/CLEVELAND DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/11/2025
Certification Date: 05/03/2023
Deactivation Date: 02/18/2022
Reactivation Date: 05/03/2023

III. Provider practice location address

764 OLD CHATTANOOGA PK SW
CLEVELAND TN
37364-0007
US

IV. Provider business mailing address

764 OLD CHATTANOOGA PK SW PO BOX 7
CLEVELAND TN
37364-0007
US

V. Phone/Fax

Practice location:
  • Phone: 423-338-5238
  • Fax:
Mailing address:
  • Phone: 423-472-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberMD0000020193
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11041
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012009
License Number StateTN

VIII. Authorized Official

Name: MR. RAYMOND BROWN
Title or Position: MANAGING/DIRECTOR
Credential:
Phone: 423-472-5268