Active NPI
Tara B Bradley, MS, CCC-SLP
- Speech-Language Pathologist
- Pensacola, FL
National Provider Identifier
1720353246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3291
- Practice address
- 5045 Carpenter Creek Dr
Pensacola, FL 32503-2521 - Phone
- (850) 416-4681
- Fax
- (850) 416-7776
- NPI assigned
- Mar 16, 2012
- Last updated
- Oct 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3291 | AL | Primary |
| Developmental Therapist | 222Q00000X |
Addresses
Primary practice location
5045 Carpenter Creek Dr
Pensacola, FL 32503-2521
Mailing address
5045 Carpenter Creek Dr
Pensacola, FL 32503-2521
Phone (850) 416-4681
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12140764 | Other | AL | ASHA CERTIFICATION |
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3291 | AL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Little Talks LLC | Speech-Language Pathologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Gulf Breeze, FL
- NPI 1083360226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601942400000",
"number": "1720353246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5045 CARPENTER CREEK DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325032521",
"telephone_number": "850-416-4681",
"fax_number": "850-416-7776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5045 CARPENTER CREEK DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325032521",
"telephone_number": "850-416-4681",
"fax_number": "850-416-7776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "TARA",
"middle_name": "B",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-16",
"last_updated": "2020-10-06",
"certification_date": "2020-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AL",
"license": "3291",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFICATION",
"identifier": "12140764",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.