Provider Demographics
NPI:1437515228
Name:VANBUSKIRK, MARY (MA, SLP/CCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:MA, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3205
Mailing Address - Country:US
Mailing Address - Phone:843-388-4048
Mailing Address - Fax:
Practice Address - Street 1:1135 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3205
Practice Address - Country:US
Practice Address - Phone:843-388-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist