Individual ProviderStacey Lynn SullivanSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address275 Cambridge St, Pob-3, Boston, MA 02114-3108(617) 724-2045PECOS EnrollmentBased on the most recent information from CMS, provider Stacey Lynn Sullivan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1902158207Provider TypeIndividualFull NameSullivan, Stacey LynnCredentialMS, CCC-SLPGenderFemaleSole ProprietorNoEnumeration Date10/10/2012Last Updated10/10/2012Contact InformationPractice LocationPractice Address275 Cambridge St, Pob-3, Boston, MA 02114-3108Phone(617) 724-2045Fax(617) 724-0771Mailing LocationMailing Address275 Cambridge St, Pob-3, Boston, MA 02114-3108PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense6466Massachusetts