Kelly Sullivan, MS, CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

101055 Issued in TX

Practice address

1400 8TH Ave
Carter Rehabilitation & Fitness Center
Ft Worth, TX 76104-4110

Phone

(817) 922-2502

Fax

(817) 922-7733

NPI assigned

Apr 25, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1780975847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 8TH AVE",
            "address_2": "CARTER REHABILITATION & FITNESS CENTER",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761044110",
            "telephone_number": "817-922-2502",
            "fax_number": "817-922-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 8TH AVE",
            "address_2": "CARTER REHABILITATION & FITNESS CENTER",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761044110",
            "telephone_number": "817-922-2502",
            "fax_number": "817-922-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "credential": "MS, CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-25",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "101055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise L Sullivan, MD
• Hannah Sullivan
• Julia B Sullivan, RD, LD, MPAS, PA-C
• Kathleen A Sullivan, A.N.P.
• Kayla Sullivan, MS. CCC-SLP
• Matthew Sullivan, D.O.
• Rebecca Sullivan
• Rebecca Jeanne Sullivan, CPNP
• Zachary Joel Sullivan, DO
• Nazia Sultana, M.D.

• Speech-Language Pathologist in Ft Worth, TX
• Providers in Ft Worth, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; 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.