Provider Demographics
NPI:1134426687
Name:BUTLER, LISA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUTLER
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 1:404 SOUTHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1441
Mailing Address - Country:US
Mailing Address - Phone:419-602-0193
Mailing Address - Fax:
Practice Address - Street 1:2500 W STRUB RD STE 150
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5488
Practice Address - Country:US
Practice Address - Phone:419-626-4162
Practice Address - Fax:419-626-2071
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist