Provider Demographics
NPI:1053382119
Name:BUTLER, LINDA S (LSCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N ROCK RD
Mailing Address - Street 2:#100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1341
Mailing Address - Country:US
Mailing Address - Phone:316-636-5245
Mailing Address - Fax:316-636-4488
Practice Address - Street 1:3500 N ROCK RD
Practice Address - Street 2:#100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1341
Practice Address - Country:US
Practice Address - Phone:316-636-5245
Practice Address - Fax:316-636-4488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW9521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11257OtherBCBS
KS11257OtherBCBS