MEDICARE: ANNELISA BUTCHER PPS

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	101YS0200X	School Counselor		CA

General Provider Information

NPI Number	:	1891650065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNELISA BUTCHER PPS

Provider Business Mailing Address
First Line	:	6844 ALEXANDRIA PL
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-2498
Country	:	US
Telephone Number	:	209-953-8932
Fax Number	:

Provider Business Practice Location Address
First Line	:	6844 ALEXANDRIA PL
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-2498
Country	:	US
Telephone Number	:	209-953-8932
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ ANNELISA BUTCHER PPS” Practice Location

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