Provider Demographics
NPI:1992020200
Name:BUTLER, PRISCILLA CAMPBELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:CAMPBELL
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S STATE ST APT 1015
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2987
Mailing Address - Country:US
Mailing Address - Phone:312-498-2128
Mailing Address - Fax:773-913-6158
Practice Address - Street 1:30 N MICHIGAN AVE STE 1622
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3668
Practice Address - Country:US
Practice Address - Phone:773-424-2128
Practice Address - Fax:773-913-6158
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical