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General NPI Number Information
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NPI Number | 1265017149
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Entity Type | Individual
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Provider Name | MANDI BUSS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 680 NORTH LAKE SHORE DRIVE SUITE 110 #1678
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-999-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 345 W. WASHINGTON AVE SUITE 301 #2011
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City | MADISON
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State | WI
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Zip | 53703-3007
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Country | US
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Telephone | 312-999-0201
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 103205-875
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149016096
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License Number State | IL
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