Provider Demographics
NPI:1265685655
Name:KUTTESCH, CYNTHIA ROSE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ROSE
Last Name:KUTTESCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 ROYCROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4820
Mailing Address - Country:US
Mailing Address - Phone:716-839-2359
Mailing Address - Fax:
Practice Address - Street 1:234 ROYCROFT BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4820
Practice Address - Country:US
Practice Address - Phone:716-839-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004655-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist