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Individual

CODY SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
23 GEREMONTY DR, SALEM, NH 03079-3314
(603) 893-5586
Mailing address
23 GEREMONTY DR, SALEM, NH 03079-3314

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
NH
235Z00000X
Speech-Language Pathologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P-0721
P-SLP
NH
Enumeration date
08/23/2018
Last updated
08/23/2018
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