Provider Demographics
NPI:1861751653
Name:RICE, BRADLEY D JR (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:RICE
Suffix:JR
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 1:22881 N 103RD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2757
Mailing Address - Country:US
Mailing Address - Phone:847-890-5703
Mailing Address - Fax:833-815-2428
Practice Address - Street 1:22881 N 103RD LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2757
Practice Address - Country:US
Practice Address - Phone:847-890-5703
Practice Address - Fax:833-815-2428
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7758235Z00000X
AZTSLP7758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty