Healthcare Provider Details

I. General information

NPI: 1255961884
Provider Name (Legal Business Name): TERESA ROSE BUSS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W ADAMS ST
CHICAGO IL
60607-2801
US

IV. Provider business mailing address

1233 W ADAMS ST
CHICAGO IL
60607-2801
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-8487
  • Fax:
Mailing address:
  • Phone: 312-243-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48123
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: