Provider Demographics
NPI:1144325218
Name:BUTLER, JILL C (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 BLACKBERRY HILLS LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6192
Mailing Address - Country:US
Mailing Address - Phone:618-910-4052
Mailing Address - Fax:618-964-9211
Practice Address - Street 1:6800 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-465-0124
Practice Address - Fax:618-465-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156442235Z00000X
IL146003170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist