=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215998166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGUERITE VASSHTI BUTLER PH.D., L.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2006
-----------------------------------------------------
Last Update Date | 08/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 PARK AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55404-3378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-774-0011
-----------------------------------------------------
Fax | 651-774-0606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4557 OAKLAND AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55407-3533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-227-0455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 4506
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------