Provider Demographics
NPI:1841452232
Name:HUTTO, LYDIA E (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:E
Last Name:HUTTO
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 POSTELL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1804
Mailing Address - Country:US
Mailing Address - Phone:912-294-3371
Mailing Address - Fax:
Practice Address - Street 1:2601 PARKWOOD DR STE E
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4724
Practice Address - Country:US
Practice Address - Phone:229-985-2080
Practice Address - Fax:229-890-3397
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCET001328OtherSPEECH PATHOLOGY