| Doctor Name: | KELLY SULLIVAN |
| NPI Number: | 1780975847 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC/SLP |
| License Number: | 101055 |
| Business Practice Address: | 1400 8th Ave Carter Rehabilitation & Fitness Center Ft Worth, TX - 761044110 |
| Business Phone Number: | 8179222502 |
| Business Fax Number: | 8179227733 |
| Mailing Address: | 1400 8th Ave, Carter Rehabilitation & Fitness Center FT WORTH |
| State: | TX |
| Postal Code: | 761044110 |
| Phone Number: | 8179222502 |
| Fax Number: | 8179227733 |
| NPI Enumeration Date: | 04/25/2011 |
| NPI Last Update Date: | 04/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 101055 |
| 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 |