Provider Demographics
NPI:1861807398
Name:SULLIVAN, BRIANNA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 COMMUNITY DR
Mailing Address - Street 2:APT #2108
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2742
Mailing Address - Country:US
Mailing Address - Phone:908-591-0109
Mailing Address - Fax:
Practice Address - Street 1:12794 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-753-4998
Practice Address - Fax:561-753-4911
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist