Individual
AMY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.-SLP
Contact information
Practice address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(224) 654-8208
(225) 654-4642
Mailing address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(224) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8133
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8133
STATE LICENSE
LA
Enumeration date
07/30/2018
Last updated
07/30/2018
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