Provider Demographics
NPI:1215610050
Name:BRADLEY, BROOKLYN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:
Other - Last Name:PLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 E IRON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2697
Mailing Address - Country:US
Mailing Address - Phone:785-414-9422
Mailing Address - Fax:785-200-3765
Practice Address - Street 1:645 E IRON AVE STE C
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2697
Practice Address - Country:US
Practice Address - Phone:785-414-9422
Practice Address - Fax:785-200-3765
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist