Provider Demographics
NPI:1225104466
Name:BUTLER, RONA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RONA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6321
Mailing Address - Country:US
Mailing Address - Phone:404-985-1143
Mailing Address - Fax:866-571-4905
Practice Address - Street 1:783 DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6321
Practice Address - Country:US
Practice Address - Phone:404-985-1143
Practice Address - Fax:866-571-4905
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52212171-001OtherBCBS PROVIDER ID
GA727277875AMedicaid
GA727277875DMedicaid
GA10054271Medicaid