Individual
SHANNA PATRICIA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 453-1400
(414) 453-2538
Mailing address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 453-1400
(414) 453-2538
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7586-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083888382
—
WI
05
—
1114192499
—
WI
Enumeration date
06/02/2010
Last updated
10/05/2021
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