Provider Demographics
NPI:1710397310
Name:BRADLEY, KATHRYN WIKER (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:WIKER
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:TAYLOR
Other - Last Name:WIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 E LINDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1023
Mailing Address - Country:US
Mailing Address - Phone:973-256-7220
Mailing Address - Fax:
Practice Address - Street 1:25 E LINDSLEY RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1023
Practice Address - Country:US
Practice Address - Phone:973-256-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00765200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist