Provider Demographics
NPI:1720690910
Name:SUTTON, JOYCE (LSW, MED)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3455
Mailing Address - Country:US
Mailing Address - Phone:419-343-2164
Mailing Address - Fax:
Practice Address - Street 1:5600 MONROE ST STE 103B
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2795
Practice Address - Country:US
Practice Address - Phone:419-885-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00130691041C0700X
OHLSP01287103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical