Provider Demographics
NPI:1629281175
Name:TUTT, KAREN A (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:TUTT
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10097 MANCHESTER RD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1828
Mailing Address - Country:US
Mailing Address - Phone:314-394-1911
Mailing Address - Fax:
Practice Address - Street 1:10097 MANCHESTER RD
Practice Address - Street 2:SUITE 102A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1828
Practice Address - Country:US
Practice Address - Phone:314-394-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024387231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107160005Medicare PIN
MO424500001Medicare PIN
MOMA5819007Medicare PIN