Provider Demographics
NPI:1528071081
Name:BUTKUS, SHANNON E (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:E
Last Name:BUTKUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N TIMBER TOP DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1445
Mailing Address - Country:US
Mailing Address - Phone:713-614-1876
Mailing Address - Fax:713-222-2678
Practice Address - Street 1:18 N TIMBER TOP DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1445
Practice Address - Country:US
Practice Address - Phone:713-614-1876
Practice Address - Fax:713-222-2678
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179859701Medicaid
TX179859702Medicaid