Individual
MRS. JILL MARIE SULLIVAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MS CCCSLP
Contact information
Practice address
307 CANON LANE, MALVERN, AR 72104
(501) 605-7808
(501) 844-4434
Mailing address
307 CANON LANE, MALVERN, AR 72104
(501) 605-7808
(501) 844-4434
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
739
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X415
BCBS
AR
Enumeration date
05/10/2006
Last updated
07/08/2007
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