Provider Demographics
NPI:1992053227
Name:BUTLER, BROOKE ALISON (MS,SLP-L, TSSLD)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ALISON
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS,SLP-L, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 AMHERST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-514-8486
Mailing Address - Fax:540-301-3618
Practice Address - Street 1:1330 AMHERST ST
Practice Address - Street 2:SUITE D
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-514-8486
Practice Address - Fax:540-301-3618
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP001459235Z00000X
VA2202007430235Z00000X
NY022100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022100OtherNEW YORK STATE LICENSE