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NPI Code Detail

MEDICARE: MRS. ELIZABETH SULLIVAN JURY MA, CCC SLP A

MEDICARE: MRS. ELIZABETH SULLIVAN JURY MA, CCC SLP A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3843MA

General Provider Information

NPI Number : 1013115948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH SULLIVAN JURY MA, CCC SLP A
Provider Business Mailing Address
First Line : 65 E GLEN DR
Second Line :
City : WESTFIELD
State : MA
Zip : 01085-1260
Country : US
Telephone Number : 413-572-2958
Fax Number :
Provider Business Practice Location Address
First Line : 65 E GLEN DR
Second Line :
City : WESTFIELD
State : MA
Zip : 01085-1260
Country : US
Telephone Number : 413-572-2958
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. ELIZABETH SULLIVAN JURY MA, CCC SLP A” Practice Location

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