Individual
LAURIE LUCKER SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 N 11TH ST FL 2, DEPT. OF SPECIAL EDUCATION, SAINT LOUIS, MO 63101-1015
(314) 633-5354
Mailing address
4127 PARKER AVE, SAINT LOUIS, MO 63116-3721
(618) 334-3657
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2012029922
MO
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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