Provider Demographics
NPI:1225130420
Name:SULLIVAN, JENNY ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 CIBOLA FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4576
Mailing Address - Country:US
Mailing Address - Phone:210-599-8970
Mailing Address - Fax:
Practice Address - Street 1:6601 BLANCO RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6102
Practice Address - Country:US
Practice Address - Phone:210-525-8851
Practice Address - Fax:210-525-8854
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist