MEDICARE: STEPHANIE BUTCHER

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	252Y00000X	Early Intervention Provider Agency	SP# 2563	AR

General Provider Information

NPI Number	:	1851716005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE BUTCHER

Provider Business Mailing Address
First Line	:	3300 CLIFF DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5917
Country	:	US
Telephone Number	:	479-226-2805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 CLIFF DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5917
Country	:	US
Telephone Number	:	479-226-2805
Fax Number	:

Authorized Official
Title or Position	:	SLP
Name	:	STEPHANIE BUTCHER
Credential	:	MS, CCC-SLP
Telephone Number	:	479-226-2805

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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