Healthcare Provider Details

I. General information

NPI: 1710463096
Provider Name (Legal Business Name): CORINNE GISELE SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORINNE HASKARD M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FALES AVE
NORWOOD MA
02062-1536
US

IV. Provider business mailing address

55 FALES AVE
NORWOOD MA
02062-1536
US

V. Phone/Fax

Practice location:
  • Phone: 507-794-9092
  • Fax:
Mailing address:
  • Phone: 978-771-6493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number76890
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: