Provider Demographics
NPI:1699250092
Name:BUSCH, MIRANDA KAYLIN
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAYLIN
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 1:19260 SW 65TH AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-691-9777
Mailing Address - Fax:503-692-6736
Practice Address - Street 1:19260 SW 65TH AVE THE CHILDREN' S CLINIC
Practice Address - Street 2:SUITE 340
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-691-9777
Practice Address - Fax:503-692-6736
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst