Provider Demographics
NPI:1699234716
Name:SUTHERLAND, VANESSA RUIZ (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:RUIZ
Last Name:SUTHERLAND
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 1:124 HILLSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210
Mailing Address - Country:US
Mailing Address - Phone:276-698-4509
Mailing Address - Fax:
Practice Address - Street 1:STONEWALL JACKSON ELEMENTARY SCHOOL
Practice Address - Street 2:2045 EUCLID AVE
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:276-821-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist