Individual
THERESA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
315 E DUNKLIN ST, JEFFERSON CITY, MO 65101-3128
(573) 659-3033
(573) 632-3475
Mailing address
315 E DUNKLIN ST, JEFFERSON CITY, MO 65101-3128
(573) 659-3033
(573) 632-3475
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LIFETIME
MO
Other
Enumeration date
02/26/2008
Last updated
02/26/2008
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