Idelle Butler Shane, MSW BCD LCSW

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

311 E Main St Ste 604
Galesburg, IL 61401-4882

Phone

(309) 341-2727

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Idelle Butler Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275663114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E. MAIN ST. STE.604",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614014855",
            "telephone_number": "309-342-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E MAIN ST STE 604",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614014882",
            "telephone_number": "309-341-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANE",
        "first_name": "IDELLE",
        "middle_name": "BUTLER",
        "credential": "MSW BCD LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD CERT DIPLOMATE",
            "identifier": "002425",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IDELLE",
            "last_name": "BUTLER",
            "credential": "BCD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Shana M Sewick, MS, LAT, ATC
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• Lucy Shannon, LPN
• Deborah Jean Shearer
• Sherilee Shepard, MHP
• Bailee Shepherd, LCP
• Michelle Sherman

• Specialist in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.