Jacqueline P Sullivan, M.A.,CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA313 Issued in FL

Practice address

1400 S Orlando Ave
Winter Park, FL 32789-5543

Phone

(407) 257-0625

Fax

(407) 876-3466

NPI assigned

Nov 26, 2007

Last updated

Nov 26, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196035200000",
    "number": "1033390653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 W 2ND AVE",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347868517",
            "telephone_number": "407-257-0625",
            "fax_number": "407-876-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S ORLANDO AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895543",
            "telephone_number": "407-257-0625",
            "fax_number": "407-876-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "P",
        "credential": "M.A.,CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-26",
        "last_updated": "2007-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.