Provider Demographics
NPI:1669926200
Name:SULLIVAN, CAROLYN YVONNE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:YVONNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2343
Mailing Address - Country:US
Mailing Address - Phone:864-200-8825
Mailing Address - Fax:864-984-8113
Practice Address - Street 1:301 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2343
Practice Address - Country:US
Practice Address - Phone:864-200-8825
Practice Address - Fax:864-984-8113
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1297642355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant