Individual
MRS. MANDY JO SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
20 N 13TH ST, MURPHYSBORO, IL 62966-2057
(618) 687-2378
(618) 687-2733
Mailing address
353 S LEWIS LN, CARBONDALE, IL 62901-3441
(708) 625-1339
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-10-7895
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1-10-7895
—
IL
Enumeration date
11/11/2010
Last updated
05/04/2018
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