Individual
AUTUMN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1553 11TH ST, WEST LINN, OR 97068-4636
(503) 816-0329
Mailing address
1553 11TH ST, WEST LINN, OR 97068-4636
(503) 816-0329
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
10950
OR
Other
Enumeration date
09/19/2014
Last updated
11/08/2023
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