Individual
MICHELE MARIE BUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
STATE ROAD 531, TIERRA AMARILLA, NM 87575-9701
(505) 588-7285
Mailing address
PO BOX 496, CHAMA, NM 87520-0496
(505) 756-1023
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3472
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61128007
—
NM
Enumeration date
12/18/2006
Last updated
07/08/2007
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