Provider Demographics
NPI:1427596576
Name:BUTLER, KATHLEEN MARY (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129A HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2304
Mailing Address - Country:US
Mailing Address - Phone:516-742-5243
Mailing Address - Fax:516-742-3536
Practice Address - Street 1:129A HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2305
Practice Address - Country:US
Practice Address - Phone:516-742-5243
Practice Address - Fax:516-742-3536
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYJTEGD21A850112781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY