Individual
JACLYN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3500
Mailing address
2319 S HORIZON DR, APPLETON, WI 54915-5847
(920) 609-3314
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
244739
WI
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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