Provider Demographics
NPI:1194968552
Name:SUTTON, SANDRA K (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 ALBATROSS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7143
Mailing Address - Country:US
Mailing Address - Phone:814-450-0857
Mailing Address - Fax:
Practice Address - Street 1:6303 ALBATROSS DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7143
Practice Address - Country:US
Practice Address - Phone:814-450-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002027L235Z00000X
NC9490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist