Individual
MICHELLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
450 SYNDICATE ST N, SAINT PAUL, MN 55104-4107
(763) 689-5385
Mailing address
7869 JENNER AVE S, COTTAGE GROVE, MN 55016-5225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5227
MN
235Z00000X
Speech-Language Pathologist
527
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4600797
MEDICA
MN
01
—
481T6SU
BCBS
MN
01
—
HP48149
HEALTH PARTNERS
MN
Enumeration date
10/18/2006
Last updated
07/09/2007
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