Provider Demographics
NPI:1386160968
Name:SULLIVAN, KARA E
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E REPUBLIC RD APT 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6557
Mailing Address - Country:US
Mailing Address - Phone:417-689-2962
Mailing Address - Fax:
Practice Address - Street 1:800 N CHEYENNE RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-6581
Practice Address - Country:US
Practice Address - Phone:417-689-2962
Practice Address - Fax:417-689-2962
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist