Provider Demographics
NPI:1124320783
Name:BRADBERRY, ASHLEY RAE (MA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RAE
Last Name:BRADBERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 BERRYESSA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7122
Mailing Address - Country:US
Mailing Address - Phone:209-639-0818
Mailing Address - Fax:
Practice Address - Street 1:4330 N PERSHING AVE
Practice Address - Street 2:SUITE B21
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6953
Practice Address - Country:US
Practice Address - Phone:209-639-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist