Individual
JACLYN ANN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12910 S LA GRANGE RD, PALOS PARK, IL 60464-1717
(708) 448-1234
Mailing address
12910 S LA GRANGE RD, PALOS PARK, IL 60464-1717
(708) 448-1234
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.011457
IL
237700000X
Hearing Instrument Specialist
2676
IL
Other
Enumeration date
08/18/2019
Last updated
04/24/2024
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