Provider Demographics
NPI:1861767220
Name:BUTLER, MARK L (BANS, AAS, BC-HIS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:M
Credentials:BANS, AAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8669
Mailing Address - Country:US
Mailing Address - Phone:775-624-9540
Mailing Address - Fax:
Practice Address - Street 1:1247 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8669
Practice Address - Country:US
Practice Address - Phone:775-624-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS #356237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist