Provider Demographics
NPI:1093180945
Name:BUSH, TONEISHA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TONEISHA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 EDGEFIELD RD STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6406
Mailing Address - Country:US
Mailing Address - Phone:803-292-5200
Mailing Address - Fax:866-464-6522
Practice Address - Street 1:616 EDGEFIELD RD STE 140
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6406
Practice Address - Country:US
Practice Address - Phone:803-292-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5581OtherLICENSE