Provider Demographics
NPI:1427326404
Name:BRADWELL, GRACIELA
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:BRADWELL
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 1:27043 BAKER POTTS RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3761
Mailing Address - Country:US
Mailing Address - Phone:956-792-4542
Mailing Address - Fax:
Practice Address - Street 1:27043 BAKER POTTS RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3761
Practice Address - Country:US
Practice Address - Phone:956-792-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218312101Medicaid
TX218312102Medicaid