Provider Demographics
NPI:1285906818
Name:BUTSON, STEPHANIE A (MA, SLPCCC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BUTSON
Suffix:
Gender:F
Credentials:MA, SLPCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 GOLDEN VALLEY RD APT 217
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4459
Mailing Address - Country:US
Mailing Address - Phone:612-518-8508
Mailing Address - Fax:
Practice Address - Street 1:1260 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3700
Practice Address - Country:US
Practice Address - Phone:651-639-0942
Practice Address - Fax:651-639-1718
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist