Healthcare Provider Details

I. General information

NPI: 1023146735
Provider Name (Legal Business Name): ASHLEY BUBA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 PURPLE HERON DR
AUSTIN TX
78746-7468
US

IV. Provider business mailing address

3506 PURPLE HERON DR
AUSTIN TX
78746-7468
US

V. Phone/Fax

Practice location:
  • Phone: 213-804-9737
  • Fax:
Mailing address:
  • Phone: 213-804-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: