Healthcare Provider Details

I. General information

NPI: 1043424625
Provider Name (Legal Business Name): DEBORAH KUTCH MS, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DRIVE
STANFORD CA
94035
US

IV. Provider business mailing address

300 PASTEUR DRIVE
STANFORD CA
94035
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-5116
  • Fax: 650-725-5433
Mailing address:
  • Phone: 650-725-5116
  • Fax: 650-725-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP5002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: