Provider Demographics
NPI:1396169769
Name:HUTTON, LORETTA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NOLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-8404
Mailing Address - Country:US
Mailing Address - Phone:567-444-4800
Mailing Address - Fax:
Practice Address - Street 1:950 E OAK ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-2223
Practice Address - Country:US
Practice Address - Phone:419-335-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 10461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist