Mallory Boehler Bradley, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009174 Issued in GA

Practice address

719 Rosedale Rd
Woodstock, GA 30189-6106

Phone

(731) 439-0642

NPI assigned

Aug 18, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1497200521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 ROSEDALE RD",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896106",
            "telephone_number": "731-439-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 ROSEDALE RD",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896106",
            "telephone_number": "731-439-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MALLORY",
        "middle_name": "BOEHLER",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Paige Bouwkamp, OTD, OTR/L
• Jaycee D Bowers, LPN
• Brittany Bowman
• Kylie Jules Boyle, NP
• Angie S Bradley, PA-C
• Sedrick Bradley, M.D.
• Stephanie Bradley, LPC
• Molly Teeling Bradshaw, RN
• Shannon Bragg
• Kristen Routzahn Braid, LCSW

• Speech-Language Pathologist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.