MEDICARE: MS. VICKI LOUISE BUSS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	001715	MO

General Provider Information

NPI Number	:	1013296086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI LOUISE BUSS MSW

Provider Business Mailing Address
First Line	:	3705 WAYSIDE DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-2123
Country	:	US
Telephone Number	:	573-474-4140
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 VANDIVER DR
Second Line	:	BLDG 6; SUITE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	573-442-8330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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