Mariah Lindsey Bradley, SLP
Individual provider Active NPI Speech-Language Pathologist · Dacula, GA
NPI 1306530795 · NPPES record last updated Jun 7, 2023
Key facts
- NPI
- 1306530795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- PCET003795 (GA)
- Practice address
- 3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907 - Phone
- (678) 377-9634
- Fax
- (678) 377-9609
- NPI assigned
- Jun 7, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCET003795 | GA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | PCET003795 | GA | Yes |
Addresses
Primary practice location
3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Mailing address
3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Phone (678) 377-9634
Other providers in Dacula, GA
- Blue Genesis Holdings LLC
- Desiree M Blunt
- Marguerite Bonnet
- Rebecca Lynn Born
- Alicia Boyd
- Mit Brahmbhatt
- Rene Bran Jr.
- Ashley Erin Brandt
- Brave Spaces Counseling & Consulting, LLC
- Jason Chandler Brewer
All providers in Dacula, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.