Provider Demographics
NPI:1558501643
Name:HUTTON, DIANA SUE (MED)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:SUE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 DEER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-4009
Mailing Address - Country:US
Mailing Address - Phone:859-802-7816
Mailing Address - Fax:859-341-9053
Practice Address - Street 1:852 DEER RIDGE CT
Practice Address - Street 2:
Practice Address - City:VILLA HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-4009
Practice Address - Country:US
Practice Address - Phone:859-802-7816
Practice Address - Fax:859-341-9053
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000044611222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist