Provider Demographics
NPI:1750868956
Name:SULLIVAN, ANAIS GONZALEZ
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:GONZALEZ
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 1:3613 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1158
Mailing Address - Country:US
Mailing Address - Phone:956-466-8391
Mailing Address - Fax:
Practice Address - Street 1:14160 DALLAS PKWY STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4356
Practice Address - Country:US
Practice Address - Phone:956-466-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant