Healthcare Provider Details

I. General information

NPI: 1851434427
Provider Name (Legal Business Name): MARY R SAUTER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 19TH AVE E
TACOMA WA
98445-5557
US

IV. Provider business mailing address

2379 S 6TH ST
FORT LEWIS WA
98433-1057
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-2727
  • Fax: 253-471-2730
Mailing address:
  • Phone: 253-267-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004218
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: