Healthcare Provider Details

I. General information

NPI: 1457446098
Provider Name (Legal Business Name): MARY SUE BUTLER LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EAST 1ST STREET
DULUTH MN
55805
US

IV. Provider business mailing address

1401 EAST FIRST STREET
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-4491
  • Fax: 218-728-4404
Mailing address:
  • Phone: 218-728-4404
  • Fax: 218-728-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2211
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: