Active NPI
Maya Victoria Bradley, M.ED., CCC-SLP
- Speech-Language Pathologist
- Warner Robins, GA
National Provider Identifier
1396589792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP012995
- Practice address
- 905 Arrowhead TRL
Warner Robins, GA 31088-5390 - Phone
- (478) 333-6076
- NPI assigned
- Jun 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP012995 | GA | Primary |
Addresses
Primary practice location
905 Arrowhead TRL
Warner Robins, GA 31088-5390
Mailing address
301 Old Mast CV
Lizella, GA 31052-3648
Phone (478) 361-8625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP012995 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1396589792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 OLD MAST CV",
"city": "LIZELLA",
"state": "GA",
"postal_code": "310523648",
"telephone_number": "478-361-8625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 ARROWHEAD TRL",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310885390",
"telephone_number": "478-333-6076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "MAYA",
"middle_name": "VICTORIA",
"credential": "M.ED., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-20",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP012995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warner Robins, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.