Provider Demographics
NPI:1487078804
Name:BUTTERS, MAKYLA (SLP CF)
Entity type:Individual
Prefix:
First Name:MAKYLA
Middle Name:
Last Name:BUTTERS
Suffix:
Gender:F
Credentials:SLP CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1933
Mailing Address - Country:US
Mailing Address - Phone:801-357-9881
Mailing Address - Fax:
Practice Address - Street 1:601 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4085
Practice Address - Country:US
Practice Address - Phone:801-357-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-3690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist