Provider Demographics
NPI:1215488390
Name:O'SULLIVAN, ALICIA LIA (AUD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LIA
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1348
Mailing Address - Country:US
Mailing Address - Phone:508-674-3334
Mailing Address - Fax:508-674-5855
Practice Address - Street 1:1822 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1348
Practice Address - Country:US
Practice Address - Phone:508-674-3334
Practice Address - Fax:508-674-5855
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4674231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist