Provider Demographics
NPI:1821272816
Name:SUTTON, BETTY D (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:D
Last Name:SUTTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2503
Mailing Address - Country:US
Mailing Address - Phone:601-894-1343
Mailing Address - Fax:601-894-3505
Practice Address - Street 1:765 GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2503
Practice Address - Country:US
Practice Address - Phone:601-894-1343
Practice Address - Fax:601-894-3505
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08721214Medicaid