Healthcare Provider Details

I. General information

NPI: 1780549352
Provider Name (Legal Business Name): ABBY NICOLE SUTHERLAND M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY NICOLE MOHLER M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 FOURTH ST
NAVARRE FL
32566-7531
US

IV. Provider business mailing address

8055 FOURTH ST
NAVARRE FL
32566-7531
US

V. Phone/Fax

Practice location:
  • Phone: 850-204-8030
  • Fax:
Mailing address:
  • Phone: 850-204-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: