Active NPI
Stacey Lynn Sullivan, MS, CCC-SLP
- Speech-Language Pathologist
- Boston, MA
National Provider Identifier
1902158207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6466
- Practice address
- 275 Cambridge St
Pob-3
Boston, MA 02114-3108 - Phone
- (617) 724-2045
- Fax
- (617) 724-0771
- NPI assigned
- Oct 10, 2012
- 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 | 6466 | MA | Primary |
Addresses
Primary practice location
275 Cambridge St
Pob-3
Boston, MA 02114-3108
Mailing address
275 Cambridge St
Pob-3
Boston, MA 02114-3108
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6466 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349827200000",
"number": "1902158207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 CAMBRIDGE ST",
"address_2": "POB-3",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 CAMBRIDGE ST",
"address_2": "POB-3",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143108",
"telephone_number": "617-724-2045",
"fax_number": "617-724-0771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "STACEY",
"middle_name": "LYNN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-10",
"last_updated": "2012-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "6466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.