Provider Demographics
NPI:1023158805
Name:BUTLER, SARA R (MA CCC SLP L)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:R
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA CCC SLP L
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:R
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC SLP L
Mailing Address - Street 1:7750 VIDA AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF LAKEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6642
Mailing Address - Country:US
Mailing Address - Phone:815-455-4058
Mailing Address - Fax:815-479-1827
Practice Address - Street 1:7750 VIDA AVE
Practice Address - Street 2:
Practice Address - City:VILLAGE OF LAKEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60014-6642
Practice Address - Country:US
Practice Address - Phone:815-455-4058
Practice Address - Fax:815-479-1827
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist