Individual
JESSICA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4192
(217) 876-2680
(217) 876-2630
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4192
(217) 876-2680
(217) 876-2630
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.015000
IL
235Z00000X
Speech-Language Pathologist
2008023621
MO
235Z00000X
Speech-Language Pathologist
2949
KS
Other
Enumeration date
04/12/2009
Last updated
05/09/2022
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