Provider Demographics
NPI:1477707131
Name:BUSHEY, PHILIP ALAN (MA SLP)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ALAN
Last Name:BUSHEY
Suffix:
Gender:M
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 WOOD ST. NORTH
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730
Mailing Address - Country:US
Mailing Address - Phone:330-488-0667
Mailing Address - Fax:
Practice Address - Street 1:234 WOOD ST. NORTH
Practice Address - Street 2:
Practice Address - City:EAST CANTON
Practice Address - State:OH
Practice Address - Zip Code:44730
Practice Address - Country:US
Practice Address - Phone:330-488-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-0113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist