Provider Demographics
NPI:1164120309
Name:BUSSCHER, BRACKEN R
Entity Type:Individual
Prefix:
First Name:BRACKEN
Middle Name:R
Last Name:BUSSCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1003
Mailing Address - Country:US
Mailing Address - Phone:616-335-0750
Mailing Address - Fax:
Practice Address - Street 1:1910 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4281
Practice Address - Country:US
Practice Address - Phone:231-354-2588
Practice Address - Fax:231-421-7046
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician