Provider Demographics
NPI:1588897003
Name:DUTTON, JERILYN NICOLE (AUD)
Entity type:Individual
Prefix:DR
First Name:JERILYN
Middle Name:NICOLE
Last Name:DUTTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7759 HERSCHEL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4478
Mailing Address - Country:US
Mailing Address - Phone:619-519-3568
Mailing Address - Fax:
Practice Address - Street 1:7759 HERSCHEL AVE
Practice Address - Street 2:STE B
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4478
Practice Address - Country:US
Practice Address - Phone:619-534-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2690231H00000X
CO574231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12147264OtherCAQH