Provider Demographics
NPI:1518526912
Name:BUSCH, KAITLIN ROSEMARY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ROSEMARY
Last Name:BUSCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ROSEMARY
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3292 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-365-8920
Mailing Address - Fax:616-365-8971
Practice Address - Street 1:400 SHERWOOD ST
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1280
Practice Address - Country:US
Practice Address - Phone:269-694-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist