Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301014081 | MI |
NPI | 1073750519 |
---|---|
Provider Name | Ms. Rebecca Sue Busman |
First Address | Grand Rapids, MI 49503-4304 |
Second Address | Grand Rapids, MI 49503-4304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |