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NPI Code Detail

MEDICARE: MRS. JULIA ASHLEY LEONARD BUSH M.S., CCC-SLP

MEDICARE: MRS. JULIA ASHLEY LEONARD BUSH M.S., 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
1235Z00000XSpeech-Language Pathologist009258GA

General Provider Information

NPI Number : 1043663511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIA ASHLEY LEONARD BUSH M.S., CCC-SLP
Provider Business Mailing Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-740-0784
Fax Number :
Provider Business Practice Location Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-740-0784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2016
Last Update Date : 04/02/2018

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