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General NPI Number Information
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NPI Number | 1073991378
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Entity Type | Organization
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Legal Business Name | CHRIS BUTTERWORTH SPEECH LANGUAGE PATHOLOGY, LLC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1904 ADAMS AVE # 20
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City | LA GRANDE
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State | OR
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Zip | 97850-2918
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Country | US
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Telephone | 603-738-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 ADAMS AVE # 20
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City | LA GRANDE
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State | OR
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Zip | 97850-2918
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Country | US
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Telephone | 603-738-4985
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MR. CHRISTOPHER FREDERICK BUTTERWORTH SR.
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Credential | CCC-SLP
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Telephone | 603-738-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 013465
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License Number State | OR
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