Provider Demographics
NPI:1649397399
Name:BRUTTER, ALLA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:
Last Name:BRUTTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTH AVE APT 5V
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2409
Mailing Address - Country:US
Mailing Address - Phone:201-461-1255
Mailing Address - Fax:201-461-2705
Practice Address - Street 1:555 NORTH AVE APT 5V
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2409
Practice Address - Country:US
Practice Address - Phone:201-461-1255
Practice Address - Fax:201-461-2705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00319400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist