Individual
JESSICA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
925 ELM GROVE RD STE 303, ELM GROVE, WI 53122-2572
(414) 375-9314
Mailing address
5721 N 58TH ST, MILWAUKEE, WI 53218-2424
(414) 375-9314
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4600-226
WI
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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