Individual
IDELLE BUTLER SHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW BCD LCSW
Contact information
Practice address
311 E MAIN ST STE 604, GALESBURG, IL 61401-4882
(309) 341-2727
Mailing address
311 E. MAIN ST. STE.604, GALESBURG, IL 61401-4855
(309) 342-2727
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002425
BOARD CERT DIPLOMATE
IL
Enumeration date
03/07/2007
Last updated
07/08/2007
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