Healthcare Provider Details

I. General information

NPI: 1760371728
Provider Name (Legal Business Name): EMMA KATHRYN BUSH LCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 N WESTERN AVE
CHICAGO IL
60622-8947
US

IV. Provider business mailing address

1929 N CALIFORNIA AVE APT SW
CHICAGO IL
60647-6239
US

V. Phone/Fax

Practice location:
  • Phone: 773-799-4342
  • Fax:
Mailing address:
  • Phone: 773-799-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227019411
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: