Lisa Bazzano Bradford, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP003520 Issued in GA

Practice address

3462 Essex Ave
Atlanta, GA 30339-5752

Phone

(678) 612-6023

Fax

(770) 980-1293

NPI assigned

May 18, 2007

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

Other names 1

• Miss Lisa Jeanne Bazzano Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972711596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3462 ESSEX AVE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395752",
            "telephone_number": "678-612-6023",
            "fax_number": "770-980-1293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3462 ESSEX AVE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395752",
            "telephone_number": "678-612-6023",
            "fax_number": "770-980-1293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "LISA",
        "middle_name": "BAZZANO",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP003520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "BAZZANO",
            "middle_name": "JEANNE",
            "prefix": "MISS",
            "credential": "MA CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrea Carol Bradford, MD
• Caroline Grace Bradford
• Charles Shannon Bradford Jr., M.D.
• Kathleen Cuneo Bradford, NP
• Laetitia Bradford, PHARMD
• Mary Anne Bradford, OT
• Tinzley Juanita Bradford, WELLNESS COACH
• Bradley-Davino Psychological Associates, PC
• Bridget R. Bradley, RN
• Brittany Eleanor Bradley, CRNA

• Speech-Language Pathologist in Atlanta, GA
• Providers in Atlanta, 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 Jul 8, 2007; 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.