Provider Demographics
NPI:1639231996
Name:SUTTON, KERRI JO
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:JO
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181125
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-7125
Mailing Address - Country:US
Mailing Address - Phone:216-224-5969
Mailing Address - Fax:216-231-9933
Practice Address - Street 1:12429 CEDAR RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3199
Practice Address - Country:US
Practice Address - Phone:216-224-5969
Practice Address - Fax:216-231-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI102201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical