Healthcare Provider Details

I. General information

NPI: 1447951843
Provider Name (Legal Business Name): SUSAN BUTTERFIELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E HARPOLE ST
WILLIAMSVILLE IL
62693-9714
US

IV. Provider business mailing address

PO BOX 42
WILLIAMSVILLE IL
62693-0042
US

V. Phone/Fax

Practice location:
  • Phone: 217-416-6494
  • Fax:
Mailing address:
  • Phone: 217-416-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149023581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: