MEDICARE: ASHLEY BUBA MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1023146735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BUBA MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3506 PURPLE HERON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-7468
Country	:	US
Telephone Number	:	213-804-9737
Fax Number	:

Provider Business Practice Location Address
First Line	:	3506 PURPLE HERON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-7468
Country	:	US
Telephone Number	:	213-804-9737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	04/14/2013

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