Provider Demographics
NPI:1336736651
Name:SUTKIN, PATRICIA BRODSKY (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BRODSKY
Last Name:SUTKIN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 RENOIR LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1700
Mailing Address - Country:US
Mailing Address - Phone:972-742-1035
Mailing Address - Fax:
Practice Address - Street 1:12516 RENOIR LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1700
Practice Address - Country:US
Practice Address - Phone:972-742-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist