Provider Demographics
NPI:1881774784
Name:SUTTER, JUDITH (PHD CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:SUTTER
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3911
Mailing Address - Country:US
Mailing Address - Phone:480-857-6786
Mailing Address - Fax:480-857-0726
Practice Address - Street 1:2130 E HOWE AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4818
Practice Address - Country:US
Practice Address - Phone:480-894-5574
Practice Address - Fax:480-894-2755
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ568355Medicaid