Provider Demographics
NPI:1285287342
Name:KILEY, SULLIVAN JAMES (MS)
Entity type:Individual
Prefix:
First Name:SULLIVAN
Middle Name:JAMES
Last Name:KILEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:SULLY
Other - Middle Name:JAMES
Other - Last Name:KILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-0248
Mailing Address - Country:US
Mailing Address - Phone:541-408-7209
Mailing Address - Fax:
Practice Address - Street 1:470 SIAS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5872
Practice Address - Country:US
Practice Address - Phone:802-585-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist