Provider Demographics
NPI:1770123788
Name:BUTTELWERTH, JULIE DEE (MSSA, LLMSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:DEE
Last Name:BUTTELWERTH
Suffix:
Gender:F
Credentials:MSSA, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 KENMOOR AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8624
Mailing Address - Country:US
Mailing Address - Phone:616-200-4433
Mailing Address - Fax:
Practice Address - Street 1:781 KENMOOR AVE SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8624
Practice Address - Country:US
Practice Address - Phone:616-200-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011019431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical