Provider Demographics
NPI:1184362949
Name:BUTLER, MAGGIE SULLIVAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:SULLIVAN
Last Name:BUTLER
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 1:9215 PLANO RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2914
Mailing Address - Country:US
Mailing Address - Phone:214-708-7705
Mailing Address - Fax:
Practice Address - Street 1:1115 MAYFIELD AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5039
Practice Address - Country:US
Practice Address - Phone:972-926-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist