Provider Demographics
NPI:1154119329
Name:BUTLER, SHANDRA RAE (MED LDT, CALT)
Entity type:Individual
Prefix:MRS
First Name:SHANDRA
Middle Name:RAE
Last Name:BUTLER
Suffix:
Gender:
Credentials:MED LDT, CALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 BINZ ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7503
Mailing Address - Country:US
Mailing Address - Phone:713-397-3525
Mailing Address - Fax:
Practice Address - Street 1:2419 BINZ ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7503
Practice Address - Country:US
Practice Address - Phone:713-397-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3118103TM1800X, 174400000X, 222Q00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist