Provider Demographics
NPI:1073064069
Name:BUSTAMANTE, BARBARA LYNNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNNA
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNNA
Other - Last Name:BUSTAMANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1630 COLUMBIA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3602
Mailing Address - Country:US
Mailing Address - Phone:202-745-2006
Mailing Address - Fax:202-939-4717
Practice Address - Street 1:111 MICHIGAN AVENUE NW
Practice Address - Street 2:CHILDRENS NATIONAL HEALTH SYSTEM
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-745-2006
Practice Address - Fax:202-939-4717
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP001042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist