Individual
DR. MICHAEL SULLIVAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, P5AUD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
2412 NE 30TH AVE, PORTLAND, OR 97212-4922
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11227
OR
Other
Enumeration date
06/12/2006
Last updated
07/08/2007
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