Provider Demographics
NPI:1265017149
Name:BUSS, MANDI (LCSW)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:BUSS
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 1:345 W. WASHINGTON AVE
Mailing Address - Street 2:SUITE 301 #2011
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3007
Mailing Address - Country:US
Mailing Address - Phone:312-999-0201
Mailing Address - Fax:
Practice Address - Street 1:680 NORTH LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 110 #1678
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-999-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103205-8751041C0700X
IL1490160961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical