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NPI Code Detail

MEDICARE: LAURA LEE SULLIVAN M.S.CLINICALREHABSE

MEDICARE: LAURA LEE SULLIVAN M.S.CLINICALREHABSE
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 PathologistSP10411CA

General Provider Information

NPI Number : 1215889332
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA LEE SULLIVAN M.S.CLINICALREHABSE
Provider Business Mailing Address
First Line : 816 CURTIS ST
Second Line :
City : ALBANY
State : CA
Zip : 94706-1804
Country : US
Telephone Number : 415-572-0614
Fax Number :
Provider Business Practice Location Address
First Line : 4351 BROADWAY
Second Line :
City : OAKLAND
State : CA
Zip : 94611-4612
Country : US
Telephone Number : 510-879-2305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2026
Last Update Date : 02/11/2026

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Directions to “ LAURA LEE SULLIVAN M.S.CLINICALREHABSE” Practice Location

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