Provider Demographics
NPI:1376677047
Name:TUTTON, KATHLEEN SUE (MS, CCC-LSP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SUE
Last Name:TUTTON
Suffix:
Gender:F
Credentials:MS, CCC-LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156-0255
Mailing Address - Country:US
Mailing Address - Phone:262-495-4748
Mailing Address - Fax:
Practice Address - Street 1:2000 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2787
Practice Address - Country:US
Practice Address - Phone:262-506-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1570-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41203900Medicaid