Provider Demographics
NPI:1437356862
Name:SUTTON, TRACI D (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:D
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4362
Mailing Address - Country:US
Mailing Address - Phone:405-447-3327
Mailing Address - Fax:
Practice Address - Street 1:1412 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6662
Practice Address - Country:US
Practice Address - Phone:405-740-1667
Practice Address - Fax:405-321-8892
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100668310Medicaid