Provider Demographics
NPI:1568181204
Name:SUTTON, COURTNEY L
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 LANTERN SQ APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4758
Mailing Address - Country:US
Mailing Address - Phone:319-939-6691
Mailing Address - Fax:
Practice Address - Street 1:212 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1454
Practice Address - Country:US
Practice Address - Phone:515-733-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist