Healthcare Provider Details

I. General information

NPI: 1720573041
Provider Name (Legal Business Name): JESSICA BUTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E SOUTH TEMPLE STE 550
SALT LAKE CITY UT
84111-1237
US

IV. Provider business mailing address

370 E SOUTH TEMPLE STE 550
SALT LAKE CITY UT
84111-1237
US

V. Phone/Fax

Practice location:
  • Phone: 385-212-4195
  • Fax:
Mailing address:
  • Phone: 385-212-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12855765
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: