Healthcare Provider Details

I. General information

NPI: 1922838069
Provider Name (Legal Business Name): GRACE ELIZABETH BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E MAIN ST
MESA AZ
85201-7417
US

IV. Provider business mailing address

7501 E MCDOWELL RD APT 2131
SCOTTSDALE AZ
85257-3579
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-0200
  • Fax:
Mailing address:
  • Phone: 253-548-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17473
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: