Provider Demographics
NPI:1912565441
Name:BUTTRY, TANYA DAWN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:DAWN
Last Name:BUTTRY
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4332
Mailing Address - Country:US
Mailing Address - Phone:859-302-1938
Mailing Address - Fax:
Practice Address - Street 1:2712 GARRETT DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4332
Practice Address - Country:US
Practice Address - Phone:859-302-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist