Individual
JACQUELINE RAE SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
118 E MAIN ST, ANAMOSA, IA 52205-1871
(319) 533-2916
Mailing address
PO BOX 425, ANAMOSA, IA 52205-0425
(319) 533-2916
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001793
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0665950
—
IA
Enumeration date
01/05/2009
Last updated
05/19/2010
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