Provider Demographics
NPI:1528694759
Name:BOHUSLAV, AMY (BS)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BOHUSLAV
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12321 HUNTERS CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0227
Mailing Address - Country:US
Mailing Address - Phone:817-360-6484
Mailing Address - Fax:
Practice Address - Street 1:12321 HUNTERS CROSSING LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0227
Practice Address - Country:US
Practice Address - Phone:817-360-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant