Provider Demographics
NPI:1952061954
Name:BARAN-BUTLER, LORELEI JEANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:JEANE
Last Name:BARAN-BUTLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:916 S WESTHILL CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2119
Mailing Address - Country:US
Mailing Address - Phone:812-360-1130
Mailing Address - Fax:
Practice Address - Street 1:916 S WESTHILL CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2119
Practice Address - Country:US
Practice Address - Phone:812-360-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002171A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist