Provider Demographics
NPI:1962774885
Name:BUSKER, JENNIFER (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUSKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:BUSKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1035 N WOOD ST
Mailing Address - Street 2:3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3262
Mailing Address - Country:US
Mailing Address - Phone:773-879-1383
Mailing Address - Fax:
Practice Address - Street 1:3245 GROVE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3474
Practice Address - Country:US
Practice Address - Phone:773-879-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional