Provider Demographics
NPI:1609110972
Name:SULLIVAN, JAIME LEE
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:LEE
Other - Last Name:TESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MAKING WAVES SPEECH LANGUAGE AND FEEDING THERAPY INC
Mailing Address - Street 2:20 INDUSTRIAL PARK DRIVE
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-882-4500
Mailing Address - Fax:603-882-4545
Practice Address - Street 1:338 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1637
Practice Address - Country:US
Practice Address - Phone:508-770-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1454235Z00000X
MA8839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist