Provider Demographics
NPI:1528057833
Name:MELANCON, BRADFORD B (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:B
Last Name:MELANCON
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Gender:M
Credentials:MS, CCC-A
Other - Prefix:
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Mailing Address - Street 1:7739 NORTHCROSS DR
Mailing Address - Street 2:SUITE U
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1700
Mailing Address - Country:US
Mailing Address - Phone:512-452-9200
Mailing Address - Fax:512-452-9211
Practice Address - Street 1:7739 NORTHCROSS DR
Practice Address - Street 2:SUITE U
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1700
Practice Address - Country:US
Practice Address - Phone:512-452-9200
Practice Address - Fax:512-452-9211
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX91059237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531515OtherBC/BS
TX531515OtherBC/BS