Provider Demographics
NPI:1770637415
Name:BUSBY, ROBERT ALLEN (PHD SPEECH THERAPI)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:BUSBY
Suffix:
Gender:M
Credentials:PHD SPEECH THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3049
Mailing Address - Country:US
Mailing Address - Phone:320-291-9806
Mailing Address - Fax:320-262-5150
Practice Address - Street 1:930 MEADOW LN
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3049
Practice Address - Country:US
Practice Address - Phone:320-291-9806
Practice Address - Fax:320-262-5150
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10067850CMedicaid
OK376591RBMedicare ID - Type UnspecifiedAPRIL 25, 2005