Provider Demographics
NPI:1144345356
Name:BUTTERFIELD, JEANNA M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:M
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-8711
Mailing Address - Country:US
Mailing Address - Phone:307-388-0955
Mailing Address - Fax:
Practice Address - Street 1:82 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-8711
Practice Address - Country:US
Practice Address - Phone:307-388-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-6841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY134196100Medicaid
WY108969205Medicaid
WY134196100Medicaid