Provider Demographics
NPI:1376958116
Name:BUTCHER, LISA RENEE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:GERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1500 PARK CENTRAL DR STE 501
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6949
Mailing Address - Country:US
Mailing Address - Phone:720-516-5000
Mailing Address - Fax:
Practice Address - Street 1:1500 PARK CENTRAL DR STE 501
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:720-516-5000
Practice Address - Fax:720-516-5001
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO719231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22386815Medicaid
CO365613YLTTOtherMEDICARE PTAN