Provider Demographics
NPI:1174349815
Name:BRADLEY, KELLY WOODS
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:WOODS
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 HUNSAKER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5758
Mailing Address - Country:US
Mailing Address - Phone:925-285-4087
Mailing Address - Fax:
Practice Address - Street 1:2350 MONUMENT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3954
Practice Address - Country:US
Practice Address - Phone:925-686-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA9017237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist