Provider Demographics
NPI:1194840132
Name:BUSCH, VIRGINIA SMITH (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:SMITH
Last Name:BUSCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2069
Mailing Address - Country:US
Mailing Address - Phone:919-383-7585
Mailing Address - Fax:
Practice Address - Street 1:115 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3251
Practice Address - Country:US
Practice Address - Phone:919-560-5600
Practice Address - Fax:919-560-3018
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411662Medicaid