Provider Demographics
NPI:1730814120
Name:MCCLENDON, BRADFORD BRYAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:BRYAN
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 HIGHWAY 1061
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-6245
Mailing Address - Country:US
Mailing Address - Phone:985-517-6763
Mailing Address - Fax:
Practice Address - Street 1:79131 HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-9334
Practice Address - Country:US
Practice Address - Phone:985-892-3636
Practice Address - Fax:985-892-3169
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist