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NPI Code Detail

MEDICARE: MS. JULIE DEE BUTTELWERTH MSSA, LLMSW

MEDICARE: MS. JULIE DEE BUTTELWERTH MSSA, LLMSW
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
11041C0700XClinical Social Worker6801101943MI

General Provider Information

NPI Number : 1770123788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE DEE BUTTELWERTH MSSA, LLMSW
Provider Business Mailing Address
First Line : 781 KENMOOR AVE SE STE C
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8624
Country : US
Telephone Number : 616-200-4433
Fax Number :
Provider Business Practice Location Address
First Line : 781 KENMOOR AVE SE STE C
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8624
Country : US
Telephone Number : 616-200-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2020
Last Update Date : 01/08/2020

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