Provider Demographics
NPI:1174668636
Name:BUTZ, KRISTIN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18955-1048
Mailing Address - Country:US
Mailing Address - Phone:267-371-4573
Mailing Address - Fax:267-371-4676
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHLANDTOWN
Practice Address - State:PA
Practice Address - Zip Code:18955-1048
Practice Address - Country:US
Practice Address - Phone:267-371-4573
Practice Address - Fax:267-371-4676
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396648Medicare Oscar/Certification
PA396761Medicare Oscar/Certification