DEDRA BUTEYN LPC-IT
NPI 1104689736
Counselor - Professional in Appleton, WI
About Dedra Buteyn Lpc-it NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEDRA BUTEYN LPC-IT (NPI 1104689736) is an individual professional provider in Appleton, Wisconsin, licensed in Wisconsin (7067-226) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dedra Buteyn Lpc-it is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Dedra Buteyn reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Appleton, WI 54911
- Reassigned Medicare billing, Wisconsin enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dedra Buteyn's NPI number?
The NPI number for Dedra Buteyn is 1104689736. It was assigned to this individual provider in the NPPES registry on February 5, 2024.
Where is Dedra Buteyn located?
Dedra Buteyn practices at 626 E Longview Dr, Appleton, WI 54911. The listed phone number is (920) 215-0107.
What is Dedra Buteyn's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Dedra Buteyn enrolled in Medicare?
Yes. Dedra Buteyn is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Dedra Buteyn's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Dedra Buteyn reassigns Medicare benefits to Illuminate Mental Health And Wellness Group (Appleton, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dedra Buteyn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Dedra Buteyn accept?
Health plans from Anthem Blue Cross and Blue Shield, Medica and UnitedHealthcare list Dedra Buteyn as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Dedra Buteyn was last updated on May 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dedra Buteyn, LPC-IT · NPI 1104689736
Professional provider in Appleton, Wisconsin. Individual provider, active in the CMS NPPES registry since February 5, 2024.
## Identity
- **NPI:** 1104689736 (Entity type: Individual)
- **Enumerated:** February 5, 2024
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 7067-226 (Wisconsin)
- **Sole proprietor:** No
## Practice location
- **Address:** 626 E LONGVIEW DR, Appleton, WI 54911-2130
- **Phone:** (920) 215-0107
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Illuminate Mental Health And Wellness Group (NPI 1629959721, Appleton, WI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** May 6, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104689736) · Data from the CMS NPPES public registry.