MEDICARE: CINDY JO BUSHELL MA, 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	SP1185	NV

General Provider Information

NPI Number	:	1265741029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY JO BUSHELL MA, CCC,SLP

Provider Business Mailing Address
First Line	:	2532 MONARCH BAY DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-328-6345
Fax Number	:	702-562-9248

Provider Business Practice Location Address
First Line	:	3555 W RENO AVE
Second Line	:	SUITE F
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1609
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “ CINDY JO BUSHELL MA, CCC,SLP” Practice Location

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