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NPI Code Detail

MEDICARE: LAUREN BUSH MS, CCC-SLP

MEDICARE: LAUREN BUSH MS, 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 PathologistSZ8064FL

General Provider Information

NPI Number : 1174006415
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN BUSH MS, CCC-SLP
Provider Business Mailing Address
First Line : 3901 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4312
Country : US
Telephone Number : 904-345-7336
Fax Number :
Provider Business Practice Location Address
First Line : 14286 BEACH BLVD STE 34
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32250-1570
Country : US
Telephone Number : 904-345-7511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 09/12/2018

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Directions to “ LAUREN BUSH MS, CCC-SLP” Practice Location

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