Healthcare Provider Details

I. General information

NPI: 1942863980
Provider Name (Legal Business Name): SUTTON SPEECH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 HAMBURG TPKE STE 224
WAYNE NJ
07470-5056
US

IV. Provider business mailing address

17 RUMSON RD
LIVINGSTON NJ
07039-3312
US

V. Phone/Fax

Practice location:
  • Phone: 516-476-1260
  • Fax:
Mailing address:
  • Phone: 516-476-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAOMI SUTTON
Title or Position: OWNER
Credential: CCC-SLP
Phone: 516-476-1260