Provider Demographics
NPI:1932495033
Name:SUTTER, WALLACE DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:DEAN
Last Name:SUTTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 SACAGAWEA DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-8924
Mailing Address - Country:US
Mailing Address - Phone:406-690-5359
Mailing Address - Fax:
Practice Address - Street 1:5330 SACAGAWEA DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-8924
Practice Address - Country:US
Practice Address - Phone:406-690-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCSW 4031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical