Provider Demographics
NPI:1467734574
Name:BUSCHER, KELLY JO (BA MHP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:BUSCHER
Suffix:
Gender:F
Credentials:BA MHP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA MHP
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1047
Mailing Address - Country:US
Mailing Address - Phone:217-347-7179
Mailing Address - Fax:217-342-6716
Practice Address - Street 1:1200 N 4TH ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3032
Practice Address - Country:US
Practice Address - Phone:217-347-7179
Practice Address - Fax:217-342-6716
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor