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General NPI Number Information
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NPI Number | 1639081086
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Entity Type | Individual
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Provider Name | ELIZABETH ROSE SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 939 N HARRISON RD
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City | EAST LANSING
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State | MI
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Zip | 48823-3062
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Country | US
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Telephone | 517-333-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 644 HILLCREST AVE
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City | EAST LANSING
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State | MI
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Zip | 48823-3236
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Country | US
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Telephone | 248-225-8139
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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 | 7101003314
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License Number State | MI
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