Individual
KEVIN A. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.I.S.W.
Contact information
Practice address
1500 W. MAIN ST. STE 300, PHOENIX COUNSELING, SUN PRAIRIE, WI 53590
(608) 825-6711
(608) 834-6499
Mailing address
1532 W. MAIN ST., STE. 100, SUN PRAIRIE, WA 53590
(608) 825-7226
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
328
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39-728100
—
WI
Enumeration date
08/27/2008
Last updated
08/27/2008
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