Healthcare Provider Details

I. General information

NPI: 1265741029
Provider Name (Legal Business Name): CINDY JO BUSHELL MA, CCC,SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W RENO AVE SUITE F
LAS VEGAS NV
89118-1609
US

IV. Provider business mailing address

2532 MONARCH BAY DRIVE
LAS VEGAS NV
89128
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax:
Mailing address:
  • Phone: 702-328-6345
  • Fax: 702-562-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1185
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: