Individual
MICHELE L SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7216 S SEVEN OAKS LN, CANBY, OR 97013-9531
(503) 680-2497
Mailing address
7216 S SEVEN OAKS LN, CANBY, OR 97013-9531
(503) 680-2497
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
17056
OR
Other
Enumeration date
01/26/2010
Last updated
01/26/2010
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