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NPI Code Detail

MEDICARE: KATHLEEN MARY O'SULLIVAN

MEDICARE:   KATHLEEN MARY O'SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistIL

General Provider Information

NPI Number : 1356460521
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN MARY O'SULLIVAN
Provider Business Mailing Address
First Line : 1918 N WOOD ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1152
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 307 W GRAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60610-4140
Country : US
Telephone Number : 312-238-6855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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Directions to “ KATHLEEN MARY O'SULLIVAN ” Practice Location

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