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General NPI Number Information
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NPI Number | 1053511204
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Entity Type | Individual
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Provider Name | JILLIAN LEIGH BUSCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 2629 REDWING RD STE 295
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City | FORT COLLINS
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State | CO
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Zip | 80526-6316
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Country | US
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Telephone | 970-480-7220
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Fax | 720-815-0268
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Provider Business Mailing Address
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Address Line | 2813 ZENDT DR
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City | FORT COLLINS
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State | CO
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Zip | 80526-6217
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Country | US
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Telephone | 970-480-7220
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Fax | 720-815-0268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.119067
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 16300A
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 55402-020
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 47570
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License Number State | CO
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