Individual
BRENDA SULLIVAN-RICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1102 MAKSIN RD, ELKVILLE, IL 62932-2220
(618) 559-5035
Mailing address
1102 MAKSIN RD, ELKVILLE, IL 62932-2220
(618) 559-5035
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-006017
IL
1041C0700X
Clinical Social Worker
149006017
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370966854004
—
IL
01
—
640701
PTAN
IL
Enumeration date
07/13/2007
Last updated
10/24/2023
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