Healthcare Provider Details

I. General information

NPI: 1760718373
Provider Name (Legal Business Name): JILL K BUSBY AVILA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL K BUSBY

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 34TH ST
BAKERSFIELD CA
93301-2237
US

IV. Provider business mailing address

8302 ESPRESSO DR STE 100
BAKERSFIELD CA
93312-5687
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax: 661-616-9199
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: