Healthcare Provider Details

I. General information

NPI: 1174668636
Provider Name (Legal Business Name): KRISTIN BUTZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S MAIN ST
RICHLANDTOWN PA
18955-1048
US

IV. Provider business mailing address

108 S MAIN ST
RICHLANDTOWN PA
18955-1048
US

V. Phone/Fax

Practice location:
  • Phone: 267-371-4573
  • Fax: 267-371-4676
Mailing address:
  • Phone: 267-371-4573
  • Fax: 267-371-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: