Provider Demographics
NPI:1194989525
Name:SUTTON, AMANDA JANE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JANE
Last Name:SUTTON
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 1:12000 MARKET ST
Mailing Address - Street 2:#327
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5693
Mailing Address - Country:US
Mailing Address - Phone:703-915-0804
Mailing Address - Fax:
Practice Address - Street 1:1818 LIBRARY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5619
Practice Address - Country:US
Practice Address - Phone:703-915-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist