Individual
TRICIA SULLIVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
4505 S WASATCH BLVD STE 360, SALT LAKE CITY, UT 84124-4203
(801) 541-9566
Mailing address
4505 S WASATCH BLVD STE 360, SALT LAKE CITY, UT 84124-4203
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
86376063502
UT
Other
Enumeration date
07/17/2015
Last updated
01/12/2017
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