Provider Demographics
NPI:1942182167
Name:SUTONO, HALEY SUSIE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SUSIE
Last Name:SUTONO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 VINEYARD RD APT 323
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9120
Mailing Address - Country:US
Mailing Address - Phone:559-502-5935
Mailing Address - Fax:
Practice Address - Street 1:1601 VINEYARD RD APT 323
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9120
Practice Address - Country:US
Practice Address - Phone:559-502-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician