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General NPI Number Information
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NPI Number | 1033717749
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Entity Type | Individual
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Provider Name | SULLIVAN MCCALLON FRIEDRICH M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 94-1181 KA UKA BLVD STE C
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City | WAIPAHU
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State | HI
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Zip | 96797-4485
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Country | US
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Telephone | 808-260-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 103 N SPRINGVIEW DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-5064
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Country | US
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Telephone | 270-873-9557
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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 | SLP011270
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-2306
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License Number State | HI
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