Individual
ELIZABETH MASCOLO SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCCSLP
Contact information
Practice address
720 STONERIDGE DR, SUITE 2, BOZEMAN, MT 59718-7032
(406) 556-9853
(406) 586-2732
Mailing address
129 ERIK DR, BOZEMAN, MT 59715-1745
(406) 556-9853
(406) 586-2732
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP984
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0532474
—
MT
01
—
660570
BLUE CROSS BLUE SHIELD
MT
Enumeration date
01/08/2007
Last updated
07/08/2007
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