Provider Demographics
NPI:1386818318
Name:BUTLER, CLYDE WILSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:WILSON
Last Name:BUTLER
Suffix:
Gender:M
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 1:380 WOODS COVE RD
Mailing Address - Street 2:PO BOX 1050
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2428
Mailing Address - Country:US
Mailing Address - Phone:256-259-4840
Mailing Address - Fax:256-259-4830
Practice Address - Street 1:380 WOODS COVE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2428
Practice Address - Country:US
Practice Address - Phone:256-259-4840
Practice Address - Fax:256-259-4830
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2159OtherSTATE OF AL LICENSE
AL515-20510OtherBCBS