Individual
STACEY LYNN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
275 CAMBRIDGE ST, POB-3, BOSTON, MA 02114-3108
(617) 724-2045
(617) 724-0771
Mailing address
275 CAMBRIDGE ST, POB-3, BOSTON, MA 02114-3108
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6466
MA
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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