Provider Demographics
NPI:1245274562
Name:BUTTERWORTH, JULIE ANN (MCD, CCC-SLP, BCBA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN(HOLDER)
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP, BCBA
Mailing Address - Street 1:2808 FOX MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9346
Mailing Address - Country:US
Mailing Address - Phone:870-335-2240
Mailing Address - Fax:870-931-4457
Practice Address - Street 1:2808 FOX MEADOW LANE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9346
Practice Address - Country:US
Practice Address - Phone:870-335-2240
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1326174400000X
AR1-11-8242103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U276OtherBLUECROSS PROVIDER #
AR136227721Medicaid