MEDICARE: MRS. KATHY BUSSA SPATH MS MASTERS OF SCIENC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		IL

General Provider Information

NPI Number	:	1104040385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY BUSSA SPATH MS MASTERS OF SCIENC

Provider Business Mailing Address
First Line	:	493 JUNIPER DRIVE
Second Line	:
City	:	PETERSBURG
State	:	IL
Zip	:	62675
Country	:	US
Telephone Number	:	217-899-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 LINDEN AVE
Second Line	:	PLEASANT HILL SCHOOL
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-6018
Country	:	US
Telephone Number	:	217-525-3256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. KATHY BUSSA SPATH MS MASTERS OF SCIENC” Practice Location

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