Provider Demographics
NPI:1851434427
Name:SAUTER, MARY R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:SAUTER
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 1:2379 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1057
Mailing Address - Country:US
Mailing Address - Phone:253-267-5559
Mailing Address - Fax:
Practice Address - Street 1:9503 19TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-5557
Practice Address - Country:US
Practice Address - Phone:253-471-2727
Practice Address - Fax:253-471-2730
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist