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General NPI Number Information
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NPI Number | 1497034375
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Entity Type | Individual
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Provider Name | HEATHER BUSSER-DEMARTE PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 580 W COLLEGE AVE
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City | MARQUETTE
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State | MI
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Zip | 49855-2736
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Country | US
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Telephone | 906-225-3985
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Fax |
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Provider Business Mailing Address
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Address Line | 111 AUTUMN TRL
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City | MARQUETTE
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State | MI
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Zip | 49855-9070
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007572
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014871
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License Number State | MI
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