MEDICARE: BRADLEY HUESGEN M.A.,CCC-SLP

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	2007016918	MO

General Provider Information

NPI Number	:	1518567494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY HUESGEN M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	3500 OXFORD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-4209
Country	:	US
Telephone Number	:	636-384-0015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 OXFORD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-4209
Country	:	US
Telephone Number	:	636-384-0015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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