Provider Demographics
NPI:1912224445
Name:BUSH, YOLANDA MARIE (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:MARIE
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 1:173 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1037
Mailing Address - Country:US
Mailing Address - Phone:607-796-9814
Mailing Address - Fax:
Practice Address - Street 1:173 LANCELOT DR
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1037
Practice Address - Country:US
Practice Address - Phone:607-796-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist