Healthcare Provider Details

I. General information

NPI: 1669568689
Provider Name (Legal Business Name): SHIRLEY BUTLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 W COLONIAL PKWY STE 205
INVERNESS IL
60067-4732
US

IV. Provider business mailing address

1627 W COLONIAL PKWY STE 205
INVERNESS IL
60067-4732
US

V. Phone/Fax

Practice location:
  • Phone: 847-977-4610
  • Fax: 847-229-1987
Mailing address:
  • Phone: 847-977-4610
  • Fax: 847-229-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005527
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: