MEDICARE: LISA BUTLER LSW

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	104100000X	Social Worker	150102386	IL

General Provider Information

NPI Number	:	1184183881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BUTLER LSW

Provider Business Mailing Address
First Line	:	1605 E 50TH ST APT 10B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-6123
Country	:	US
Telephone Number	:	773-941-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 E 50TH ST APT 10B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-6123
Country	:	US
Telephone Number	:	773-941-1291
Fax Number	:

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

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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Directions to “ LISA BUTLER LSW” Practice Location

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