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General NPI Number Information
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NPI Number | 1023968708
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Entity Type | Individual
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Provider Name | ANDREA SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 4440 CARVER WOODS DR
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City | BLUE ASH
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State | OH
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Zip | 45242-5529
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Country | US
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Telephone | 513-771-7655
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Fax |
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Provider Business Mailing Address
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Address Line | 12056 COOPERWOOD LN
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City | MONTGOMERY
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State | OH
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Zip | 45242-6320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.07130
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License Number State | OH
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