Provider Demographics
NPI:1962909861
Name:BUSALACCHI, GIULIANA (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:GIULIANA
Middle Name:
Last Name:BUSALACCHI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 E FISHER FWY APT 7
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2615
Mailing Address - Country:US
Mailing Address - Phone:313-580-1049
Mailing Address - Fax:
Practice Address - Street 1:8045 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2627
Practice Address - Country:US
Practice Address - Phone:313-821-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist