Provider Demographics
NPI:1417737966
Name:SUTTON, GRACE CATHERINE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CATHERINE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N55W34673 ROAD E
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2543
Mailing Address - Country:US
Mailing Address - Phone:262-825-6706
Mailing Address - Fax:
Practice Address - Street 1:13755 W FIELDPOINTE DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3979
Practice Address - Country:US
Practice Address - Phone:262-796-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6418-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist