Provider Demographics
NPI:1598020455
Name:FERGUSON-BUSCH, KRISTEN LEE (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:FERGUSON-BUSCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE RD STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:205-576-0888
Mailing Address - Fax:
Practice Address - Street 1:3418 LOMA VISTA RD STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3015
Practice Address - Country:US
Practice Address - Phone:805-269-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist