Provider Demographics
NPI:1194838870
Name:BUTTERFIELD, KIMLEE DELLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KIMLEE
Middle Name:DELLE
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7704
Mailing Address - Country:US
Mailing Address - Phone:802-863-8274
Mailing Address - Fax:
Practice Address - Street 1:403 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7704
Practice Address - Country:US
Practice Address - Phone:802-863-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00004831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006725Medicaid
VTVN1565Medicare ID - Type UnspecifiedMEDICARE B PROVIDER #
VT03-0369131Medicare UPIN