Provider Demographics
NPI:1063594166
Name:GILLMAN-BUTCHER, DANA JO
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JO
Last Name:GILLMAN-BUTCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4072
Mailing Address - Country:US
Mailing Address - Phone:606-237-1700
Mailing Address - Fax:606-237-1701
Practice Address - Street 1:260 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4072
Practice Address - Country:US
Practice Address - Phone:606-237-1700
Practice Address - Fax:606-237-1701
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3057OtherKY BOARD OF SPEECH