Individual
ANGELA CHRISTINE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
124 CHANNEL DR, LAKE MARY, FL 32746-2724
(503) 358-8182
Mailing address
124 CHANNEL DR, LAKE MARY, FL 32746-2724
(503) 358-8182
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60428847
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LL60428847
—
WA
Enumeration date
08/24/2015
Last updated
10/31/2019
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