MEDICARE: DR. JESSICA SOLKY BUTZEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS1160	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100529	OTHER	ME	BCBS PAYER NUMBER

General Provider Information

NPI Number	:	1174745814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA SOLKY BUTZEL PH.D.

Provider Business Mailing Address
First Line	:	12 LEIGHTON FARM RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-9704
Country	:	US
Telephone Number	:	207-332-7670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-332-7670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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