=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407116676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER BUTTS SPEECH THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2012
-----------------------------------------------------
Last Update Date | 05/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 21ST AVE S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-322-4500
-----------------------------------------------------
Fax | 205-323-0085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 21ST AVENUE SOUTH
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-322-4500
-----------------------------------------------------
Fax | 205-323-0085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 3325
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------