Provider Demographics
NPI:1578285367
Name:BRADNER, JEWELL DUPREE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:DUPREE
Last Name:BRADNER
Suffix:
Gender:F
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 1:6925 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1526
Mailing Address - Country:US
Mailing Address - Phone:703-906-2900
Mailing Address - Fax:
Practice Address - Street 1:6925 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1526
Practice Address - Country:US
Practice Address - Phone:703-906-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02610L235Z00000X
VA2202011154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist