Provider Demographics
NPI:1083795884
Name:BUSHARD, CHANDRA JO (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:JO
Last Name:BUSHARD
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:JO
Other - Last Name:VOIGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:3915 GOLDEN VALLEY RD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:952-898-5700
Mailing Address - Fax:952-898-5757
Practice Address - Street 1:100 COBBLESTONE LANE
Practice Address - Street 2:COURAGE BURNSVILLE
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306
Practice Address - Country:US
Practice Address - Phone:952-898-5700
Practice Address - Fax:952-898-5757
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN372G7BUOtherBCBS MINNESOTA
MNHP54024OtherHEALTHPARTNERS
MN4600937OtherMEDICA