Provider Demographics
NPI:1760197487
Name:BUSH, KOURTNEY S
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:S
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S MEADOWS RD UNIT 623
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3682
Mailing Address - Country:US
Mailing Address - Phone:318-554-8082
Mailing Address - Fax:
Practice Address - Street 1:435 SAINT MICHAELS DR STE B104
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7671
Practice Address - Country:US
Practice Address - Phone:505-946-3955
Practice Address - Fax:505-303-4688
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter