Provider Demographics
NPI:1134430069
Name:BUSH, ASHLEY H (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:BUSH
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6979 BREEZY PT
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-9177
Mailing Address - Country:US
Mailing Address - Phone:409-781-7204
Mailing Address - Fax:
Practice Address - Street 1:99 RIGBY OWEN RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1765
Practice Address - Country:US
Practice Address - Phone:936-758-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist