Healthcare Provider Details

I. General information

NPI: 1447718614
Provider Name (Legal Business Name): KRISTEN M BUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 BLAKE ST STE 220
DENVER CO
80205-4889
US

IV. Provider business mailing address

100 PARK AVE W APT 605
DENVER CO
80205-3231
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-3975
  • Fax:
Mailing address:
  • Phone: 303-905-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-25861
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: