Provider Demographics
NPI:1366711749
Name:TUTEN, EMILY THAMES (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:THAMES
Last Name:TUTEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LIGHTY LN
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-3159
Mailing Address - Country:US
Mailing Address - Phone:904-307-1178
Mailing Address - Fax:
Practice Address - Street 1:1717 LIGHTY LN
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-3159
Practice Address - Country:US
Practice Address - Phone:904-307-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist