Provider Demographics
NPI:1417770090
Name:BUSTER, EMILY NICOLE (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:BUSTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 W PFEIFFER RD
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 LIGHTFOOT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61531
Practice Address - Country:US
Practice Address - Phone:309-245-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist