Provider Demographics
NPI:1104114842
Name:BUTALLA, CHRISTINE E (SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:E
Last Name:BUTALLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR STE 515
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6158
Mailing Address - Country:US
Mailing Address - Phone:520-661-3311
Mailing Address - Fax:
Practice Address - Street 1:6567 E CARONDELET DR STE 515
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6158
Practice Address - Country:US
Practice Address - Phone:520-661-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist