Healthcare Provider Details

I. General information

NPI: 1689599714
Provider Name (Legal Business Name): MARK HUTTON MA, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 NEWPORT ST
SAN MATEO CA
94402-3838
US

IV. Provider business mailing address

423 N CLAREMONT ST APT 1
SAN MATEO CA
94401-5403
US

V. Phone/Fax

Practice location:
  • Phone: 650-312-7544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: