Provider Demographics
NPI:1386860708
Name:GORDON BUTLER, ANN-MARIE (MA, CCC)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:GORDON BUTLER
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ELLIOT PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6246
Mailing Address - Country:US
Mailing Address - Phone:904-444-5300
Mailing Address - Fax:904-615-8285
Practice Address - Street 1:9 ELLIOT PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6246
Practice Address - Country:US
Practice Address - Phone:904-444-5300
Practice Address - Fax:904-615-8285
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386860708Medicaid
FL1386860708Medicare NSC