Provider Demographics
NPI:1053389015
Name:BUSSART, GAIL D (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:D
Last Name:BUSSART
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:D
Other - Last Name:GRASZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:560 N EXPOSITION ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5902
Mailing Address - Country:US
Mailing Address - Phone:316-854-8574
Mailing Address - Fax:316-854-5271
Practice Address - Street 1:560 N EXPOSITION ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5902
Practice Address - Country:US
Practice Address - Phone:316-854-8574
Practice Address - Fax:316-854-5271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS009021OtherPHS
KS069655OtherBCBS
KS100427820AMedicaid
KS100427820AMedicaid