Provider Demographics
NPI:1134425598
Name:SUTTON, KATHRYN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-423-7791
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:415 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1230
Practice Address - Country:US
Practice Address - Phone:812-423-7791
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340062391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100240880Medicaid
IN000000711608OtherANTHEM
IN12227768OtherCAQH
IN000000711608OtherANTHEM