Provider Demographics
NPI:1154957231
Name:BUSS, TAYLOR KAYLENE (LISW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KAYLENE
Last Name:BUSS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 TRAVER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5165
Mailing Address - Country:US
Mailing Address - Phone:216-224-0756
Mailing Address - Fax:
Practice Address - Street 1:3693 TRAVER RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5165
Practice Address - Country:US
Practice Address - Phone:216-224-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18013221041C0700X
I.1801322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker