Provider Demographics
NPI:1629344494
Name:SUTTON, NAOMI (SLP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RUMSON RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3312
Mailing Address - Country:US
Mailing Address - Phone:516-476-1260
Mailing Address - Fax:
Practice Address - Street 1:1211 HAMBURG TPKE STE 224
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5056
Practice Address - Country:US
Practice Address - Phone:973-800-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00635500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist