Provider Demographics
NPI:1295174936
Name:DUTTON, SUSAN R (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-2643
Mailing Address - Country:US
Mailing Address - Phone:610-469-3199
Mailing Address - Fax:
Practice Address - Street 1:1863 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-2643
Practice Address - Country:US
Practice Address - Phone:610-469-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000315L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist