Provider Demographics
NPI:1932432085
Name:BUTLER, RACHEL (SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TRIPLETT ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3564
Mailing Address - Country:US
Mailing Address - Phone:270-683-4517
Mailing Address - Fax:270-852-1491
Practice Address - Street 1:815 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3564
Practice Address - Country:US
Practice Address - Phone:270-683-4517
Practice Address - Fax:270-852-1491
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004866A235Z00000X
KY3204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000035Medicaid
184517OtherMEDICARE
KY45118379Medicaid
KY11903135Medicaid