Provider Demographics
NPI:1033558036
Name:SULLIVAN, DANIELLE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:LUEBKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:3300 SAGE RD
Mailing Address - Street 2:APT 3301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3921 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-422-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002554235Z00000X
TX109835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist