Provider Demographics
NPI:1467002964
Name:KUTSMEDA, SUZANNE W (MS, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:W
Last Name:KUTSMEDA
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9760
Mailing Address - Country:US
Mailing Address - Phone:609-388-4782
Mailing Address - Fax:609-388-5193
Practice Address - Street 1:56 MAIN ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-8896
Practice Address - Country:US
Practice Address - Phone:609-388-4782
Practice Address - Fax:609-388-5193
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00396400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist