Healthcare Provider Details

I. General information

NPI: 1972411700
Provider Name (Legal Business Name): JENNA BUSCEMI M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 LINCOLN ST
OAK PARK MI
48237-1366
US

IV. Provider business mailing address

23592 NORTHPORT DR
CLINTON TOWNSHIP MI
48036-1266
US

V. Phone/Fax

Practice location:
  • Phone: 248-837-8446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14336387
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: