Individual
SUSAN SULLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 GRANDVIEW ST, CLARKS SUMMIT, PA 18411-2159
(570) 815-2132
Mailing address
508 GRANDVIEW ST, CLARKS SUMMIT, PA 18411-2159
(570) 815-2132
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH000818
PA
Other
Enumeration date
06/26/2014
Last updated
06/30/2014
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