MEDICARE: COLLEEN MARIE BUTLER

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		IL

General Provider Information

NPI Number	:	1528406105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MARIE BUTLER

Provider Business Mailing Address
First Line	:	10024 S CLAREMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1922
Country	:	US
Telephone Number	:	773-208-5818
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 W MORSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4914
Country	:	US
Telephone Number	:	630-414-1823
Fax Number	:	855-763-2747

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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Directions to “ COLLEEN MARIE BUTLER ” Practice Location

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