Provider Demographics
NPI:1922886399
Name:BUSSIER, SOPHIA KATHLEEN
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:KATHLEEN
Last Name:BUSSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 BLUE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-4100
Mailing Address - Country:US
Mailing Address - Phone:763-248-4697
Mailing Address - Fax:
Practice Address - Street 1:7615 GOLDEN TRIANGLE DR STE A
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3733
Practice Address - Country:US
Practice Address - Phone:952-767-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst