Individual
MR. BRADEN ALEC SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N/A
Contact information
Practice address
2258 N LAKEWAY CIR, WICHITA, KS 67205
(316) 945-7117
(316) 945-7447
Mailing address
3223 N OLIVER ST, WICHITA, KS 67220-2106
(316) 558-3410
(316) 267-5444
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
KS
Other
Enumeration date
06/05/2017
Last updated
06/26/2018
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