Provider Demographics
NPI:1487162947
Name:SULLIVAN, ANNA MARIA (MS-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14556 ROCKINGHAM PIKE
Mailing Address - Street 2:RIVER BEND ELEMENTARY SCHOOL
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827
Mailing Address - Country:US
Mailing Address - Phone:540-298-5301
Mailing Address - Fax:540-298-5305
Practice Address - Street 1:14556 ROCKINGHAM PIKE
Practice Address - Street 2:RIVER BEND ELEMENTARY SCHOOL
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827
Practice Address - Country:US
Practice Address - Phone:540-298-5301
Practice Address - Fax:540-298-5305
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-600-1584OtherROCKINGHAM COUNTY