Provider Demographics
NPI:1134523350
Name:BUSCHENA, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BUSCHENA
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-7500
Mailing Address - Fax:605-328-7599
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-7500
Practice Address - Fax:605-328-7599
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3359104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker