Kelly Sullivan

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

77836-SP-SL Issued in MA

Practice address

100 Cummings Ctr Ste 135H
Beverly, MA 01915-6127

Phone

(978) 927-0172

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

No

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

Enrolled in MA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Speech Therapy Group, LLC.

  • Speech-Language Pathologist
  • Beverly, MA
  • NPI 1447289103
  Medicare reassignment NPD
• The Verbal ABA Clinic, LLC

  • Behavior Analyst
  • Beverly, MA
  • NPI 1427613207
  NPD (past)

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1699375899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PRESIDENTIAL WAY UNIT 2113",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CUMMINGS CTR STE 135H",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156127",
            "telephone_number": "978-927-0172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "77836-SP-SL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gretchen Stuwe-Keohane, R.N.,C.S.
• Indra Sandrina Suckra
• Youngun Suh, PA-C
• Sullivan Chiropractic & Rehabilitation, Inc.
• Arianna Sullivan
• Kelly Mary Sullivan
• Melissa Sullivan
• Thomas Jay Sunderman
• Carl Supino
• Surrimassini, Inc.

• Speech-Language Pathologist in Beverly, MA
• Providers in Beverly, MA by specialty
• Speech-Language Pathologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.