MEDICARE: ASHLEY J BUSCH LICSW

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	LW60729567	WA

General Provider Information

NPI Number	:	1851863625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY J BUSCH LICSW

Provider Business Mailing Address
First Line	:	5615 W SUNSET HWY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-9454
Country	:	US
Telephone Number	:	509-324-3740
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 W SUNSET HWY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-9454
Country	:	US
Telephone Number	:	509-324-3740
Fax Number	:

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	04/14/2021

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