Provider Demographics
NPI:1669770988
Name:SULLIVAN, WENDY L (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:LEA MARY
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:800 TAIT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2309
Mailing Address - Country:US
Mailing Address - Phone:585-966-3880
Mailing Address - Fax:585-966-3839
Practice Address - Street 1:800 TAIT AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2309
Practice Address - Country:US
Practice Address - Phone:585-966-3880
Practice Address - Fax:585-966-3839
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007615-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist