Individual
KEJUAN SULLIVAN WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
690 DIXIE HWY, ROSSFORD, OH 43460-1221
(614) 844-3800
Mailing address
2534 KEY ST APT 3, TOLEDO, OH 43614-4806
(313) 693-0585
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2615030
—
OH
01
—
W452465778878
DRIVERS LICENSE NUMBER
MI
Enumeration date
10/10/2018
Last updated
08/28/2022
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