Provider Demographics
NPI:1265771158
Name:BUSH, CHRISTINE ANNE (SLP, MS-CCC/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:BUSH
Suffix:
Gender:F
Credentials:SLP, MS-CCC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 DILL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1531
Mailing Address - Country:US
Mailing Address - Phone:319-759-0586
Mailing Address - Fax:
Practice Address - Street 1:2813 DILL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1531
Practice Address - Country:US
Practice Address - Phone:319-759-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist