Provider Demographics
NPI:1386253920
Name:BUTZ, CECILIE
Entity type:Individual
Prefix:
First Name:CECILIE
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4N603 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2339
Mailing Address - Country:US
Mailing Address - Phone:773-544-7907
Mailing Address - Fax:
Practice Address - Street 1:4N603 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2339
Practice Address - Country:US
Practice Address - Phone:773-544-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL1-20-43486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst