Isabella Rae Eccleston Busch
Speech-Language Pathologist, in Lake Ronkonkoma, NY. Individual provider (NPI-1).
NPI number1194201848
StatusActive
Last updated in NPPESAug 23, 2022
Details
- NPI
- 1194201848
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Isabella Rae Eccleston Busch
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 16, 2018
- Certification date
- Aug 23, 2022
- Last updated
- Aug 23, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 028942 | NY | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | NY |
Other names
- Isabella Rae Rodriguez Eccleston (Former Name)
Practice location
51 School StLake Ronkonkoma, NY 11779-2298
Phone 631-471-1300
Mailing address
2615 Union BlvdIslip, NY 11751-3207
Phone 631-383-8686
Other practice locations
1560 Mayflower Ave
Bronx, NY 10461-5400
Bronx, NY 10461-5400
Phone 718-948-1900
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All 55 Speech-Language Pathologist providers in Lake Ronkonkoma · All 248 providers in Lake Ronkonkoma
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