Provider Demographics
NPI:1780839571
Name:CYR-MUTTY, JO (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:CYR-MUTTY
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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342-0183
Mailing Address - Country:US
Mailing Address - Phone:413-772-9335
Mailing Address - Fax:
Practice Address - Street 1:271 PINE NOOK RD.
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01342
Practice Address - Country:US
Practice Address - Phone:413-772-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1715-W235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01086316OtherASHA
MA1715-WOtherCOMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE SPEECH-LANGUAGE