Individual
MRS. ELIZABETH GRAL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS/CCC-SLP
Contact information
Practice address
13111 NORTH PORT WASHINGTON ROAD, MEQUON, WI 53097
(262) 243-7444
Mailing address
816 E HYDE WAY, FOX POINT, WI 53217-3221
(414) 352-6817
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
878-154
WI
Other
Enumeration date
06/16/2006
Last updated
10/30/2012
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