Provider Demographics
NPI:1326537804
Name:BUTLER, NICOLETTE LEA (AUD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:LEA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E DIMOND BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2057
Mailing Address - Country:US
Mailing Address - Phone:907-522-4357
Mailing Address - Fax:
Practice Address - Street 1:1005 E DIMOND BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2057
Practice Address - Country:US
Practice Address - Phone:907-522-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1631261Medicaid