Provider Demographics
NPI:1295044337
Name:BUTTS, REBECCA KATHLEEN (MSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KATHLEEN
Other - Last Name:MCBRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5122 KEMPF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2938
Mailing Address - Country:US
Mailing Address - Phone:314-520-0461
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-814-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker