Provider Demographics
NPI:1154691780
Name:BRADBERRY, MICHELLE (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BRADBERRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:10700 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE A7
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4191
Mailing Address - Country:US
Mailing Address - Phone:501-225-6060
Mailing Address - Fax:501-225-6450
Practice Address - Street 1:2835 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6144
Practice Address - Country:US
Practice Address - Phone:501-329-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA352231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist