Provider Demographics
NPI:1023321296
Name:BUTLER, CYNTHIA J
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:888-510-0766
Mailing Address - Fax:763-268-4430
Practice Address - Street 1:311 RIVER RD
Practice Address - Street 2:STE 103
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4113
Practice Address - Country:US
Practice Address - Phone:253-845-3190
Practice Address - Fax:253-845-3271
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00004405237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist