Provider Demographics
NPI:1679051783
Name:BUSH, KASSANDRA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5968 HASWELL PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-5870
Mailing Address - Country:US
Mailing Address - Phone:308-390-9821
Mailing Address - Fax:
Practice Address - Street 1:2323 S CODDINGTON AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1849
Practice Address - Country:US
Practice Address - Phone:402-437-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist