Individual
MS. MEREDITH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MA
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
327-228
WI
106H00000X
Marriage & Family Therapist
Primary
1047
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376944504
—
WI
Enumeration date
09/08/2014
Last updated
09/26/2016
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