Sullivan, Beth Louise
Sullivan, Beth Louise is an individual health care provider with primary practice located at 2611 12Th St S , Wisconsin Rapids WI 54494. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Sullivan, Beth Louise can be contacted via phone (715) 421-8840.Contact Information
Primary practice address
2611 12Th St S
Wisconsin Rapids WI 54494
Phone: (715) 421-8840
Fax: (715) 421-8858
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2697125 | Wisconsin |
Profile Details
| NPI number | 1760558175 |
|---|---|
| LBN Legal business name | Sullivan, Beth Louise |
| Credentials | MS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760558175 | NPPES |
| Wisconsin | MEDICAID | 39724500 |
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