Individual
LAURA BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS/CCC-SLP
Contact information
Practice address
252 LATITUDE LN STE 103, LAKE WYLIE, SC 29710-8152
(803) 818-0218
Mailing address
512 RED WOLF LN, CLOVER, SC 29710-6728
(724) 664-6945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6812
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5559
—
SC
Enumeration date
08/25/2020
Last updated
08/25/2020
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