Individual
MRS. SOFIA BAGLIVO SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
206 YORK ST APT 1, JERSEY CITY, NJ 07302-3645
(215) 512-1792
Mailing address
206 YORK ST APT 1, JERSEY CITY, NJ 07302-3645
(215) 512-1792
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
024595
NY
235Z00000X
Speech-Language Pathologist
Primary
41YS01058600
NJ
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04174021
—
NY
Enumeration date
04/15/2014
Last updated
01/19/2023
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