MEDICARE: NICOLE BUTLER M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146-008045	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636689	OTHER	IL	BCBS SPEECH THERAPY

General Provider Information

NPI Number	:	1043362759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BUTLER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	30 N GOULD ST STE N
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	800-689-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N GOULD ST STE N
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	800-689-8211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/23/2026

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Directions to “ NICOLE BUTLER M.S., CCC-SLP” Practice Location

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