Healthcare Provider Details

I. General information

NPI: 1255973475
Provider Name (Legal Business Name): KATHRYN DEANNE DUTTON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N DAVIS ST STE 101
JACKSONVILLE FL
32209-6826
US

IV. Provider business mailing address

11901 ABESS BLVD APT 1202
JACKSONVILLE FL
32225-6033
US

V. Phone/Fax

Practice location:
  • Phone: 904-355-3403
  • Fax:
Mailing address:
  • Phone: 904-945-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ8614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: