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NPI Code Detail

MEDICARE: MS. PAMELA ANN SULLIVAN SLP

MEDICARE: MS. PAMELA ANN SULLIVAN SLP
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 Pathologist1067AZ

General Provider Information

NPI Number : 1770661605
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA ANN SULLIVAN SLP
Provider Business Mailing Address
First Line : 3768 W MALAPAI DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1159
Country : US
Telephone Number : 602-938-1562
Fax Number :
Provider Business Practice Location Address
First Line : 10251 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1305
Country : US
Telephone Number : 602-995-7366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ MS. PAMELA ANN SULLIVAN SLP” Practice Location

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