Healthcare Provider Details

I. General information

NPI: 1013840990
Provider Name (Legal Business Name): KIM BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 WALNUT AVE
CARMICHAEL CA
95608-3054
US

IV. Provider business mailing address

1740 ADONIS WAY
SACRAMENTO CA
95864-1702
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7220
  • Fax:
Mailing address:
  • Phone: 916-956-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: