Provider Demographics
NPI:1750774758
Name:BUTCHER, MICHELE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BUTCHER
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 1:50668 TUMBLEWEED TRL
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9147
Mailing Address - Country:US
Mailing Address - Phone:574-277-5802
Mailing Address - Fax:
Practice Address - Street 1:50668 TUMBLEWEED TRL
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9147
Practice Address - Country:US
Practice Address - Phone:574-277-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002313A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist