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General NPI Number Information
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NPI Number | 1730814120
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Entity Type | Individual
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Provider Name | BRADFORD BRYAN MCCLENDON M.S., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 79131 HIGHWAY 40
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City | COVINGTON
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State | LA
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Zip | 70435-9334
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Country | US
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Telephone | 985-892-3636
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Fax | 985-892-3169
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Provider Business Mailing Address
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Address Line | 18205 HIGHWAY 1061
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City | AMITE
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State | LA
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Zip | 70422-6245
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Country | US
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Telephone | 985-517-6763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7559
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License Number State | LA
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