MEDICARE: CARA M BUTLER MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-1600	ID

General Provider Information

NPI Number	:	1891922936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA M BUTLER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3814 WASHINGTON PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7591
Country	:	US
Telephone Number	:	208-529-3562
Fax Number	:	208-529-5064

Provider Business Practice Location Address
First Line	:	3814 WASHINGTON PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7591
Country	:	US
Telephone Number	:	208-529-3562
Fax Number	:	208-529-5064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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Directions to “ CARA M BUTLER MS, CCC-SLP” Practice Location

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