Provider Demographics
NPI:1154604296
Name:BUSH, JULIE ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BUSH
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 1:11585 ALAMO RANCH PKWY
Mailing Address - Street 2:APT. 16202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6168
Mailing Address - Country:US
Mailing Address - Phone:210-243-6759
Mailing Address - Fax:
Practice Address - Street 1:4211 GARDENDALE ST
Practice Address - Street 2:STE. A200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3180
Practice Address - Country:US
Practice Address - Phone:210-615-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist