Healthcare Provider Details

I. General information

NPI: 1295642155
Provider Name (Legal Business Name): REBECCA BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E JOLIET ST
SCHERERVILLE IN
46375-2088
US

IV. Provider business mailing address

8400 WICKER AVE
SAINT JOHN IN
46373-9710
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-4451
  • Fax:
Mailing address:
  • Phone: 219-365-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10268777
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: