Healthcare Provider Details

I. General information

NPI: 1215840640
Provider Name (Legal Business Name): MEGAN ROSE BUSS MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ROSE NELSON

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MINNESOTA AVE
BIG LAKE MN
55309-8800
US

IV. Provider business mailing address

7618 LACHMAN AVE NE
OTSEGO MN
55301-4507
US

V. Phone/Fax

Practice location:
  • Phone: 763-262-7119
  • Fax:
Mailing address:
  • Phone: 320-292-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14528597
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: