Provider Demographics
NPI:1467193987
Name:BUZICK, AMBER (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BUZICK
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S COLUMBIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4054
Mailing Address - Country:US
Mailing Address - Phone:701-732-3367
Mailing Address - Fax:
Practice Address - Street 1:1395 S COLUMBIA RD STE A217
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4054
Practice Address - Country:US
Practice Address - Phone:701-732-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND39781041C0700X
MN183001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical