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General NPI Number Information
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NPI Number | 1417629346
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Entity Type | Individual
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Provider Name | SERENA BUTLER CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 630 E CHESTNUT HILL RD
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City | NEWARK
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State | DE
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Zip | 19713-1828
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Country | US
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Telephone | 302-454-2097
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Fax | 302-454-2497
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Provider Business Mailing Address
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Address Line | 31 WICKLOW RD
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City | BEAR
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State | DE
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Zip | 19701-6348
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Country | US
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Telephone | 302-241-8410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 01-0012009
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License Number State | DE
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