Individual
MS. NANCY JANE SULLIVAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW, MSW, MED
Contact information
Practice address
1800 COOPER POINT RD SW, BUILDING 24B, OLYMPIA, WA 98502-1178
(360) 786-1195
Mailing address
1718 8TH AVE SW, OLYMPIA, WA 98502-5216
(360) 754-9330
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00004150
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007652345
AETNA
KY
01
—
1263101000
UNIFORM MEDICAL PLAN
WA
Enumeration date
08/25/2005
Last updated
07/08/2007
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