Provider Demographics
NPI:1588308233
Name:SULLIVAN, PHOEBE CLAIRE
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:CLAIRE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOLLAND LN APT 1521
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3446
Mailing Address - Country:US
Mailing Address - Phone:305-812-0389
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD STE 118
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3404
Practice Address - Country:US
Practice Address - Phone:703-705-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist