Provider Demographics
NPI:1679224190
Name:SUTTER, MELINDA GRIFFITH
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GRIFFITH
Last Name:SUTTER
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 1:900 TECHNOLOGY WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5364
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:847-680-3832
Practice Address - Street 1:900 TECHNOLOGY WAY STE 320
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5364
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:847-680-3832
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty