Provider Demographics
NPI:1508353814
Name:BUSH, JANIE P (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:P
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E WHITESTONE BLVD UNIT 425
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-4318
Mailing Address - Country:US
Mailing Address - Phone:469-383-2822
Mailing Address - Fax:
Practice Address - Street 1:5353 WILLIAMS DR STE 100
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2069
Practice Address - Country:US
Practice Address - Phone:512-713-0521
Practice Address - Fax:512-763-8523
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist