Individual provider · NPI-1

Jill Bush, CCC-SLP

Speech-Language Pathologist, · Crestview, FL

NPI number1194083584
StatusActive
Last updated in NPPESAug 14, 2014

Details

NPI
1194083584
Entity type
Individual (NPI-1)
Name
Jill Bush
Credential
CCC-SLP
Sex
Female
Sole proprietor
Yes
Enumeration date
Apr 24, 2012
Last updated
Aug 14, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
235Z00000X Speech-Language Pathologist,SA12763FLYes
235Z00000X Speech-Language Pathologist,04630MD

Practice location

301 S Ferdon Blvd
Crestview, FL 32536-3701

Phone 850-306-1277 · Fax 850-306-1263

Mailing address

301 S Ferdon Blvd
Crestview, FL 32536-3701

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