Provider Demographics
NPI:1346625191
Name:SULLIVAN, SELAH ALLEGRA (SLP)
Entity Type:Individual
Prefix:
First Name:SELAH
Middle Name:ALLEGRA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SELAH
Other - Middle Name:ALLEGRA
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:6200 W OAKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1103
Mailing Address - Country:US
Mailing Address - Phone:702-870-7050
Mailing Address - Fax:702-870-7616
Practice Address - Street 1:6200 W OAKEY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1103
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:702-870-7616
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist