Provider Demographics
NPI:1134167836
Name:BUTALLA, RACHEL JEAN (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JEAN
Last Name:BUTALLA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:JEAN
Other - Last Name:PARLIER-BUTALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:1100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1238
Mailing Address - Country:US
Mailing Address - Phone:715-234-1515
Mailing Address - Fax:
Practice Address - Street 1:1100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1238
Practice Address - Country:US
Practice Address - Phone:715-234-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2397154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist