Provider Demographics
NPI:1669603924
Name:BUTLER, TAUSHA SHANEA (MA,CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TAUSHA
Middle Name:SHANEA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:706 AVALON CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9550
Mailing Address - Country:US
Mailing Address - Phone:330-469-5764
Mailing Address - Fax:330-448-6961
Practice Address - Street 1:8055 ADDISON RD
Practice Address - Street 2:
Practice Address - City:MASURY
Practice Address - State:OH
Practice Address - Zip Code:44438-1204
Practice Address - Country:US
Practice Address - Phone:330-448-6964
Practice Address - Fax:330-448-6961
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist