Individual
KELLSIE BUSHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
250 HAWKINS DR, IOWA CITY, IA 52242
(507) 383-9091
Mailing address
2011 CUMBERLAND CT, BROOKINGS, SD 57006-7247
(507) 383-9091
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
096458
IA
231H00000X
Audiologist
470-A
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096458
STATE LICENSE NUMBER
IA
01
—
470-A
STATE LICENSE NUMBER
SD
Enumeration date
02/13/2018
Last updated
05/03/2019
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