Provider Demographics
NPI:1215091426
Name:BUSCH, LINDA A (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 N ILLINOIS ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1899
Mailing Address - Country:US
Mailing Address - Phone:618-222-7277
Mailing Address - Fax:618-222-7305
Practice Address - Street 1:4460 N ILLINOIS ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1899
Practice Address - Country:US
Practice Address - Phone:618-222-7277
Practice Address - Fax:618-222-7305
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0098261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17454Medicare UPIN
IL211639Medicare ID - Type Unspecified