Provider Demographics
NPI:1780176560
Name:BUSHNELL, ERICA ANN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:BUSHNELL
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 1:5850 SOMERSET BLVD W
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-9061
Mailing Address - Country:US
Mailing Address - Phone:260-444-9022
Mailing Address - Fax:260-444-9022
Practice Address - Street 1:5850 SOMERSET BLVD W
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-9061
Practice Address - Country:US
Practice Address - Phone:260-444-9022
Practice Address - Fax:260-444-9022
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-17-27995103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst