Provider Demographics
NPI:1689483208
Name:BUSCH, JESSICA NOELLE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NOELLE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 ENNIS DR APT 2
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-8868
Mailing Address - Country:US
Mailing Address - Phone:304-621-2379
Mailing Address - Fax:
Practice Address - Street 1:99 ENNIS DR APT 2
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-8868
Practice Address - Country:US
Practice Address - Phone:304-621-2379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health