MEDICARE: MS. CHRISTINE E. BUTALLA 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	SLP7352	AZ

General Provider Information

NPI Number	:	1104114842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE E. BUTALLA SLP

Provider Business Mailing Address
First Line	:	6567 E CARONDELET DR STE 515
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-6158
Country	:	US
Telephone Number	:	520-661-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	6567 E CARONDELET DR STE 515
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-6158
Country	:	US
Telephone Number	:	520-661-3311
Fax Number	:

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

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	05/06/2013

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