MEDICARE: ELIZABETH A BRADSHAW 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	101581	TX

General Provider Information

NPI Number	:	1821289299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A BRADSHAW SLP

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 WOODSTEAD CT
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1507
Country	:	US
Telephone Number	:	281-681-9900
Fax Number	:

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

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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