Healthcare Provider Details

I. General information

NPI: 1295985018
Provider Name (Legal Business Name): SHANNON THERESA BUTLER M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 UNION AVE
MEMPHIS TN
38104-3941
US

IV. Provider business mailing address

1838 UNION AVE
MEMPHIS TN
38104-3941
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-0044
  • Fax: 901-726-0858
Mailing address:
  • Phone: 901-726-0044
  • Fax: 901-726-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: