Individual
MS. MARY J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
95 SKOWHEGAN RD, MAINE CENTER FOR INTEGRATED REHAB, FAIRFIELD, ME 04937-3303
(207) 453-1330
Mailing address
95 SKOWHEGAN RD, MAINE CENTER FOR INTEGRATED REHAB, FAIRFIELD, ME 04937-3303
(207) 453-1330
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1885
ME
235Z00000X
Speech-Language Pathologist
SP7845SL
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433215399
—
ME
Enumeration date
01/08/2010
Last updated
01/08/2010
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