Individual
JENNIFER RENEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2416 E WASHINGTON ST, SUITE G, BLOOMINGTON, IL 61704-4472
(309) 662-5050
Mailing address
4634 CIRCLE DR, HEYWORTH, IL 61745-9462
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-07-2352
IL
Other
Enumeration date
04/10/2009
Last updated
04/10/2009
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