Provider Demographics
NPI:1477167674
Name:BUTTARI, JESSICA A (CPT, CHT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BUTTARI
Suffix:
Gender:F
Credentials:CPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 KNOLLWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6517
Mailing Address - Country:US
Mailing Address - Phone:440-783-4173
Mailing Address - Fax:
Practice Address - Street 1:9980 KNOLLWOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6517
Practice Address - Country:US
Practice Address - Phone:440-783-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral