Provider Demographics
NPI:1801841531
Name:BUTLER, DENNIS J (PHD)
Entity Type:Individual
Prefix:MS
First Name:DENNIS
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6533
Mailing Address - Fax:414-267-3892
Practice Address - Street 1:1121 E NORTH AVE
Practice Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3515
Practice Address - Country:US
Practice Address - Phone:414-267-6533
Practice Address - Fax:414-267-3892
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801841531Medicaid
002000139XOtherHUMANA
R39847Medicare UPIN
WI1801841531Medicaid