Jacqueline Rae Sutherland, MA, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Anamosa, IA
NPI 1770729329 · NPPES record last updated May 19, 2010
Key facts
- NPI
- 1770729329
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 001793 (IA)
- Practice address
- 118 E Main St
Anamosa, IA 52205-1871 - Phone
- (319) 533-2916
- NPI assigned
- Jan 5, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001793 | IA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iowa Speech Therapy, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 001793 | IA | Yes |
Addresses
Primary practice location
118 E Main St
Anamosa, IA 52205-1871
Mailing address
PO Box 425
Anamosa, IA 52205-0425
Phone (319) 533-2916
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0665950 | Medicaid | IA |
Other providers in Anamosa, IA
- St Luke'S Jones Regional Medical Center
- St Luke'S Jones Regional Medical Center
- St Luke'S Jones Regional Medical Center
- St. Luke'S Jones Regional Medical Center
- Brooke Stammeyer
- Lawrence A. Taylor
- Dana C Thordsen
- Taylor Nicole Tittle
- TLC Healthcare LLC
- Total Eye Health Center Inc
All providers in Anamosa, IA · Speech-Language Pathologist in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.