Active NPI
Michelle Sullivan, MA, CCC-SLP
- Speech-Language Pathologist
- Waxhaw, NC
National Provider Identifier
1225207376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3615
- Practice address
- 902 Lillieshall Rd
Waxhaw, NC 28173-6673 - Phone
- (704) 843-7697
- NPI assigned
- Feb 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 3615 | NC | Primary |
Addresses
Primary practice location
902 Lillieshall Rd
Waxhaw, NC 28173-6673
Mailing address
902 Lillieshall Rd
Waxhaw, NC 28173-6673
Phone (704) 843-7697
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7401026 | Medicaid | NC |
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3615 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1225207376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 LILLIESHALL RD",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281736673",
"telephone_number": "704-843-7697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "902 LILLIESHALL RD",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281736673",
"telephone_number": "704-843-7697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHELLE",
"credential": "MA, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-22",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "3615",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7401026",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waxhaw, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.