Provider Demographics
NPI:1043663511
Name:BUSH, JULIA ASHLEY LEONARD (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ASHLEY LEONARD
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 1:340 MENDEL PKWY W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-5406
Mailing Address - Country:US
Mailing Address - Phone:334-740-0784
Mailing Address - Fax:
Practice Address - Street 1:340 MENDEL PKWY W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-5406
Practice Address - Country:US
Practice Address - Phone:334-740-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist