Provider Demographics
NPI:1356627723
Name:BUSSING, ANNA LEIGH (AUD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEIGH
Last Name:BUSSING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19662
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9662
Mailing Address - Country:US
Mailing Address - Phone:217-545-6099
Mailing Address - Fax:217-545-7386
Practice Address - Street 1:301 N 8TH ST
Practice Address - Street 2:SUITE PAV 5B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1041
Practice Address - Country:US
Practice Address - Phone:217-545-6099
Practice Address - Fax:217-545-7386
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001404231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid