Provider Demographics
NPI:1235667114
Name:BUTLER, JAIDEN SAMANTHA
Entity Type:Individual
Prefix:
First Name:JAIDEN
Middle Name:SAMANTHA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N DRYDEN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3150
Mailing Address - Country:US
Mailing Address - Phone:479-226-9096
Mailing Address - Fax:
Practice Address - Street 1:121 S DUCK ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3292
Practice Address - Country:US
Practice Address - Phone:405-372-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician