Provider Demographics
NPI:1801331194
Name:DUTSON, ERIC (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:DUTSON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 W 2880 S
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6479
Mailing Address - Country:US
Mailing Address - Phone:435-770-6116
Mailing Address - Fax:
Practice Address - Street 1:964 W 2880 S
Practice Address - Street 2:
Practice Address - City:NIBLEY
Practice Address - State:UT
Practice Address - Zip Code:84321
Practice Address - Country:US
Practice Address - Phone:435-770-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10120186-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist