Doctor Name: | JACQUELINE P SULLIVAN |
NPI Number: | 1033390653 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A.,CCC/SLP |
License Number: | SA313 |
Business Practice Address: | 1400 S Orlando Ave Winter Park, FL - 327895543 |
Business Phone Number: | 4072570625 |
Business Fax Number: | 4078763466 |
Mailing Address: | 939 W 2nd Ave, WINDERMERE |
State: | FL |
Postal Code: | 347868517 |
Phone Number: | 4072570625 |
Fax Number: | 4078763466 |
NPI Enumeration Date: | 11/26/2007 |
NPI Last Update Date: | 11/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA313 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |