Provider Demographics
NPI:1548413644
Name:MCQUEEN-SULLIVAN, JENNIFER (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MCQUEEN-SULLIVAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 234TH ST
Mailing Address - Street 2:5H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2240
Mailing Address - Country:US
Mailing Address - Phone:718-653-1436
Mailing Address - Fax:
Practice Address - Street 1:360 E 234TH ST
Practice Address - Street 2:5H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2240
Practice Address - Country:US
Practice Address - Phone:718-653-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015305-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist