Individual
MRS. STACEY ANN BUSBOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S., CCC-SLP
Contact information
Practice address
4535 CHANDLER CT, MONROE, GA 30656-3688
(770) 625-0029
Mailing address
4535 CHANDLER CT, MONROE, GA 30656-3688
(770) 625-0029
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006818
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432013779A
—
GA
Enumeration date
01/07/2009
Last updated
11/27/2023
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