Provider Demographics
NPI:1164659090
Name:BUSH, PATRICIA ANN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BUSH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38293 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16404-4803
Mailing Address - Country:US
Mailing Address - Phone:814-967-3841
Mailing Address - Fax:
Practice Address - Street 1:937 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3334
Practice Address - Country:US
Practice Address - Phone:814-724-6211
Practice Address - Fax:814-337-0188
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03380237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist