Individual
AMALIA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2520 CHAUCER CT, EUGENE, OR 97405-1217
(541) 203-6703
(541) 229-1209
Mailing address
2520 CHAUCER CT, EUGENE, OR 97405-1217
(541) 203-6703
(541) 229-1209
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7561
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500663904
—
OR
Enumeration date
08/23/2011
Last updated
02/27/2023
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