Provider Demographics
NPI:1346401072
Name:BUTLER, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:ANDRZEJCZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5030
Mailing Address - Country:US
Mailing Address - Phone:920-236-4700
Mailing Address - Fax:920-236-4607
Practice Address - Street 1:220 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5030
Practice Address - Country:US
Practice Address - Phone:920-236-4700
Practice Address - Fax:920-236-4607
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICSW 8213-120104100000X
WI8327-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker