Individual
MRS. KATORYA LATIA BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-A
Contact information
Practice address
330 AVENUE C SE, WINTER HAVEN, FL 33880-3243
(863) 268-2903
Mailing address
3605 COVINGTON LN, LAKELAND, FL 33810-2710
(813) 856-7541
(863) 940-3844
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SI4109
FL
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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