Individual
AMY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
811 KEYLON ST, MANCHESTER, TN 37355-2413
(931) 450-5150
Mailing address
811 KEYLON ST, MANCHESTER, TN 37355-2413
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2660
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2660
—
TN
Enumeration date
10/29/2019
Last updated
10/29/2019
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