Active NPI
Amy Sullivan, M.S.-SLP
- Speech-Language Pathologist
- Zachary, LA
National Provider Identifier
1063990380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8133
- Practice address
- 1326 Church St
Zachary, LA 70791-2743 - Phone
- (224) 654-8208
- Fax
- (225) 654-4642
- NPI assigned
- Jul 30, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 8133 | LA | Primary |
Addresses
Primary practice location
1326 Church St
Zachary, LA 70791-2743
Mailing address
1326 Church St
Zachary, LA 70791-2743
Phone (224) 654-8208
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8133 | Other | LA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532908800000",
"number": "1063990380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1326 CHURCH ST",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912743",
"telephone_number": "224-654-8208",
"fax_number": "225-654-4642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1326 CHURCH ST",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912743",
"telephone_number": "224-654-8208",
"fax_number": "225-654-4642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "AMY",
"credential": "M.S.-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-30",
"last_updated": "2018-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "8133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "8133",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Zachary, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.