Individual
AMY ANN BUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CF-SLP
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(253) 548-5619
Mailing address
707 SW GAINES ST, PORTLAND, OR 97239-2901
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016399
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016399
SPEECH-LANGUAGE PATHOLOGY CONDITIONAL LICENSE
OR
Enumeration date
09/13/2018
Last updated
09/13/2018
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