Provider Demographics
NPI:1235325978
Name:BUSCH, LISA MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARY
Last Name:BUSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 W 95TH ST
Mailing Address - Street 2:UNIT 305
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8912
Mailing Address - Country:US
Mailing Address - Phone:630-753-9800
Mailing Address - Fax:630-753-9798
Practice Address - Street 1:2272 W 95TH ST
Practice Address - Street 2:UNIT 305
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8912
Practice Address - Country:US
Practice Address - Phone:630-753-9800
Practice Address - Fax:630-753-9798
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005399103TC0700X
IL074.000017103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical