Provider Demographics
NPI:1922386168
Name:SUTHER, BREANNA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:MARIE
Last Name:SUTHER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:MARIE
Other - Last Name:SUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2502
Mailing Address - Country:US
Mailing Address - Phone:603-305-2947
Mailing Address - Fax:
Practice Address - Street 1:165 S RIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6926
Practice Address - Country:US
Practice Address - Phone:603-206-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77930235Z00000X
NH1364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist