Provider Demographics
NPI:1194895409
Name:O'SULLIVAN, JEANNE HUGHES (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:HUGHES
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LIBRARY WAY
Mailing Address - Street 2:185 HEWITT HALL
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3520
Mailing Address - Country:US
Mailing Address - Phone:603-862-0055
Mailing Address - Fax:603-862-4511
Practice Address - Street 1:4 LIBRARY WAY
Practice Address - Street 2:185 HEWITT HALL
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3520
Practice Address - Country:US
Practice Address - Phone:603-862-0055
Practice Address - Fax:603-862-4511
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010575Medicaid