Healthcare Provider Details

I. General information

NPI: 1114869229
Provider Name (Legal Business Name): DESTINY BUSHWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4462 BEETHOVEN AVE
SAINT LOUIS MO
63116-1514
US

IV. Provider business mailing address

4462 BEETHOVEN AVE
SAINT LOUIS MO
63116-1514
US

V. Phone/Fax

Practice location:
  • Phone: 816-325-3491
  • Fax:
Mailing address:
  • Phone: 816-325-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: