Doctor Name: | MS. JOANNA KATHLEEN SULLIVAN |
NPI Number: | 1366703571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | 332006 |
Business Practice Address: | 112 Holt Dr Madison, IN - 472503873 |
Business Phone Number: | 8122658227 |
Business Fax Number: | |
Mailing Address: | 312 Cragmont St, MADISON |
State: | IN |
Postal Code: | 472503007 |
Phone Number: | 8122654788 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2012 |
NPI Last Update Date: | 06/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 332006 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |