Individual
MALLORY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
222Q00000X
Contact information
Practice address
1745 HAMMONSVILLE JONESVILLE RD, MAGNOLIA, KY 42757-7643
(270) 766-7598
Mailing address
1745 HAMMONSVILLE JONESVILLE RD, MAGNOLIA, KY 42757-7643
(270) 766-7598
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
KY
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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