Provider Demographics
NPI:1447638358
Name:BRADFORD, MORGAN CAMILLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:CAMILLE
Last Name:BRADFORD
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:CAMILLE
Other - Last Name:BYRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:139 COVE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3135
Mailing Address - Country:US
Mailing Address - Phone:208-890-0276
Mailing Address - Fax:
Practice Address - Street 1:139 COVE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3135
Practice Address - Country:US
Practice Address - Phone:208-890-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist