Provider Demographics
NPI:1538448261
Name:SULLIVAN, SHAWN PATRICE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SHAWN
Middle Name:PATRICE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:312 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1555
Mailing Address - Country:US
Mailing Address - Phone:570-343-1950
Mailing Address - Fax:
Practice Address - Street 1:2300 ADAMS AVE
Practice Address - Street 2:MCGOWAN CENTER
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1514
Practice Address - Country:US
Practice Address - Phone:570-348-6299
Practice Address - Fax:570-961-4708
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist