Provider Demographics
NPI:1841811155
Name:SULLIVAN SPEECH AND FEEDING LLC
Entity type:Organization
Organization Name:SULLIVAN SPEECH AND FEEDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASSI
Authorized Official - Middle Name:MCLAIN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:985-373-3604
Mailing Address - Street 1:19123 MCLAIN RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-8026
Mailing Address - Country:US
Mailing Address - Phone:985-373-3604
Mailing Address - Fax:
Practice Address - Street 1:19123 MCLAIN RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-8026
Practice Address - Country:US
Practice Address - Phone:985-373-3604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty