Provider Demographics
NPI:1073945440
Name:BASTOW, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BASTOW
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 1:2601 S IH 35 STE A300
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7358
Mailing Address - Country:US
Mailing Address - Phone:512-238-1828
Mailing Address - Fax:
Practice Address - Street 1:2601 S IH 35 STE A300
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7358
Practice Address - Country:US
Practice Address - Phone:512-238-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist