Healthcare Provider Details

I. General information

NPI: 1518780204
Provider Name (Legal Business Name): BEUNKA BUTLER CADC, CHW, DUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 E 50TH ST APT 2C
CHICAGO IL
60615-2597
US

IV. Provider business mailing address

613 E 50TH ST APT 2C
CHICAGO IL
60615-2597
US

V. Phone/Fax

Practice location:
  • Phone: 773-629-7477
  • Fax:
Mailing address:
  • Phone: 773-629-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37312
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: