Provider Demographics
NPI:1821221730
Name:SUTTER, MARY MAGDALENE (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAGDALENE
Last Name:SUTTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:6592 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-4900
Mailing Address - Country:US
Mailing Address - Phone:315-525-8741
Mailing Address - Fax:
Practice Address - Street 1:7303 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402-9774
Practice Address - Country:US
Practice Address - Phone:315-893-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 017909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist