Provider Demographics
NPI:1336290519
Name:BRADSHAW, EMILY ANNETTE (MHS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANNETTE
Last Name:BRADSHAW
Suffix:
Gender:
Credentials:MHS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 N WHITETAIL WAY
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-8742
Mailing Address - Country:US
Mailing Address - Phone:816-589-2563
Mailing Address - Fax:816-526-0152
Practice Address - Street 1:6365 N WHITETAIL WAY
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-8742
Practice Address - Country:US
Practice Address - Phone:816-589-2563
Practice Address - Fax:816-526-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHE 104339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO463402339Medicaid