Provider Demographics
NPI:1053842484
Name:SUTTON, REBECCA (MA CF-CCC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MA CF-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 47TH ST W APT 425
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2827
Mailing Address - Country:US
Mailing Address - Phone:812-968-5962
Mailing Address - Fax:
Practice Address - Street 1:4550 47TH ST W APT 425
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2827
Practice Address - Country:US
Practice Address - Phone:812-968-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist