Provider Demographics
NPI:1073355814
Name:BUSBY-JORDAN, KATHRYN NICOLE (BSW, MSW)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:NICOLE
Last Name:BUSBY-JORDAN
Suffix:
Gender:F
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S 4TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6957
Mailing Address - Country:US
Mailing Address - Phone:785-473-8970
Mailing Address - Fax:
Practice Address - Street 1:104 S 4TH ST STE 203
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6957
Practice Address - Country:US
Practice Address - Phone:785-370-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13664-T104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker