Provider Demographics
NPI:1851611974
Name:BUTTS, BECKY F (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:F
Last Name:BUTTS
Suffix:
Gender:F
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 1:216 MULBERRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-6463
Mailing Address - Country:US
Mailing Address - Phone:662-419-1491
Mailing Address - Fax:
Practice Address - Street 1:176 HWY 9 N
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915
Practice Address - Country:US
Practice Address - Phone:662-412-5220
Practice Address - Fax:662-412-5221
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist