Provider Demographics
NPI:1831349000
Name:BUTLER, STACEY REBECCA (AUD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:REBECCA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:AUDIOLOGY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-8924
Mailing Address - Country:US
Mailing Address - Phone:801-662-4942
Mailing Address - Fax:801-662-4931
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:AUDIOLOGY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-8924
Practice Address - Country:US
Practice Address - Phone:801-662-4942
Practice Address - Fax:801-662-4931
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5324891-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist