Provider Demographics
NPI:1366111437
Name:SUTHERLAND, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-1562
Mailing Address - Country:US
Mailing Address - Phone:417-845-3409
Mailing Address - Fax:833-398-1630
Practice Address - Street 1:340 PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-1562
Practice Address - Country:US
Practice Address - Phone:417-223-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2025-09-08
Deactivation Date:2024-12-19
Deactivation Code:
Reactivation Date:2025-01-14
Provider Licenses
StateLicense IDTaxonomies
MO20250086122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant