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General NPI Number Information
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NPI Number | 1972265551
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Entity Type | Individual
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Provider Name | AMY BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 6168 BENTRIDGE DR
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City | HURST
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State | TX
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Zip | 76054-2615
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Country | US
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Telephone | 817-479-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 3411 OAK GROVE AVE APT 215
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City | DALLAS
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State | TX
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Zip | 75204-2394
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Country | US
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Telephone | 713-898-0220
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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 |
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License Number State |
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