MEDICARE: HEATHER M BRADFORD M.S. 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	SA7442	FL

General Provider Information

NPI Number	:	1679891949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER M BRADFORD M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2286 WEDNESDAY ST
Second Line	:	SUITE 1
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8310
Country	:	US
Telephone Number	:	850-727-7928
Fax Number	:	850-727-7931

Provider Business Practice Location Address
First Line	:	2286 WEDNESDAY ST
Second Line	:	SUITE 1
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8310
Country	:	US
Telephone Number	:	850-727-7928
Fax Number	:	850-727-7931

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

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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Directions to “ HEATHER M BRADFORD M.S. CCC-SLP” Practice Location

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