Provider Demographics
NPI:1154839926
Name:BRADSHAW, ELIZABETH A (MS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OAK POINT DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4700
Mailing Address - Country:US
Mailing Address - Phone:276-783-2609
Mailing Address - Fax:
Practice Address - Street 1:138 OAK POINT DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4700
Practice Address - Country:US
Practice Address - Phone:276-783-2609
Practice Address - Fax:276-783-2609
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22030000354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist