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General NPI Number Information
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NPI Number | 1851905053
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Entity Type | Individual
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Provider Name | NATALIE SULLIVAN MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 60 PAYSON ST
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City | WINTHROP
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State | MA
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Zip | 02152-1639
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Country | US
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Telephone | 617-846-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PECKHAM AVE
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City | NEWPORT
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State | RI
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Zip | 02840-1753
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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 | 76366
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License Number State | RI
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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 | SP01651
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP101222
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License Number State | MA
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