Provider Demographics
NPI:1457492738
Name:BUTRICK, JEANNE S (LIC'D REHAB COUNS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:S
Last Name:BUTRICK
Suffix:
Gender:F
Credentials:LIC'D REHAB COUNS
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:A
Other - Last Name:SCHELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 CHAREST LN
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3670
Mailing Address - Country:US
Mailing Address - Phone:413-786-7950
Mailing Address - Fax:
Practice Address - Street 1:622 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4104
Practice Address - Country:US
Practice Address - Phone:413-439-1200
Practice Address - Fax:413-732-4720
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA340225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor