Provider Demographics
NPI:1194060384
Name:BRADFORD, DAWN LEA
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LEA
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE HOCKING
Mailing Address - State:OH
Mailing Address - Zip Code:45742-5236
Mailing Address - Country:US
Mailing Address - Phone:740-336-2411
Mailing Address - Fax:
Practice Address - Street 1:4073 SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:LITTLE HOCKING
Practice Address - State:OH
Practice Address - Zip Code:45742-5236
Practice Address - Country:US
Practice Address - Phone:740-336-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist