Provider Demographics
NPI:1285280164
Name:BUSH, EMILY CLARE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLARE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 EDGEWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3012
Mailing Address - Country:US
Mailing Address - Phone:248-421-0311
Mailing Address - Fax:
Practice Address - Street 1:545 EDGEWOOD PASS
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3012
Practice Address - Country:US
Practice Address - Phone:248-421-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist