Individual
DEBORAH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-6514
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1376
ID
Other
Enumeration date
11/08/2013
Last updated
11/08/2013
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