Provider Demographics
NPI:1881715985
Name:SUTTER, JANE (MA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SUTTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2888
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-2888
Mailing Address - Country:US
Mailing Address - Phone:928-338-4842
Mailing Address - Fax:
Practice Address - Street 1:2337 FIR DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5586
Practice Address - Country:US
Practice Address - Phone:928-338-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1552231H00000X
AZSLPL4984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184935OtherAHCCCS
AZ927395OtherAHCCCS