Provider Demographics
NPI:1548087661
Name:BUTALA, KRISTEN ASHLEY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ASHLEY
Last Name:BUTALA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ASHLEY
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:633 BATTLEFIELD BLVD S STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4800
Mailing Address - Country:US
Mailing Address - Phone:772-342-2628
Mailing Address - Fax:
Practice Address - Street 1:633 BATTLEFIELD BLVD S STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4800
Practice Address - Country:US
Practice Address - Phone:772-342-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist