Individual
SHAWN KENNEDY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
523 WALKER ST, WOODBINE, IA 51579-1260
(712) 647-3412
Mailing address
1720 N 16TH ST STE K, COUNCIL BLUFFS, IA 51501-0109
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
132717
IA
Other
Enumeration date
08/13/2025
Last updated
08/13/2025
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