| Doctor Name: | DR. THERESA PAULETTE SULLIVAN |
| NPI Number: | 1205055076 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AUD |
| License Number: | 001886 |
| Business Practice Address: | 250 Tuytenbridge Rd Lake Katrine, NY - 124495429 |
| Business Phone Number: | 8453367235 |
| Business Fax Number: | 8453364726 |
| Mailing Address: | 513 Pine Rd, COPAKE |
| State: | NY |
| Postal Code: | 125161109 |
| Phone Number: | 5183295761 |
| Fax Number: | |
| NPI Enumeration Date: | 04/24/2007 |
| NPI Last Update Date: | 01/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 001886 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| 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 |