Individual
KELLY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
10883 SE MAIN ST, STE. 204, MILWAUKIE, OR 97222-7641
(503) 381-2422
Mailing address
PO BOX 220203, PORTLAND, OR 97269-0203
(503) 381-2422
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4631
OR
Other
Enumeration date
06/07/2011
Last updated
01/30/2017
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