Individual
MIA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 45TH ST S STE 218, FARGO, ND 58103-1189
(609) 751-7748
Mailing address
330 W 56TH ST APT 4K, NEW YORK, NY 10019-4201
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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