Provider Demographics
NPI:1437991239
Name:BRADBERRY, LEAH MANLEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MANLEY
Last Name:BRADBERRY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 KIMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2224
Mailing Address - Country:US
Mailing Address - Phone:512-983-5703
Mailing Address - Fax:
Practice Address - Street 1:16219 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5209
Practice Address - Country:US
Practice Address - Phone:512-520-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist