Doctor Name: | MRS. JILL RUCKMAN SULLIVAN |
NPI Number: | 1174724272 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC SLP |
License Number: | 100963 |
Business Practice Address: | 3411 Edmonson Ct Missouri City, TX - 774596367 |
Business Phone Number: | 2816852323 |
Business Fax Number: | 2817783702 |
Mailing Address: | 3411 Edmonson Ct, MISSOURI CITY |
State: | TX |
Postal Code: | 774596367 |
Phone Number: | 2816852323 |
Fax Number: | 2817783702 |
NPI Enumeration Date: | 05/29/2007 |
NPI Last Update Date: | 05/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 100963 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |