MEDICARE: AIMEE SULLIVAN BIBB LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L13564	OR

General Provider Information

NPI Number	:	1750898110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE SULLIVAN BIBB LCSW

Provider Business Mailing Address
First Line	:	3555 CHAD DRIVE
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405
Country	:	US
Telephone Number	:	907-957-2428
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 CHAD DRIVE
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405
Country	:	US
Telephone Number	:	541-037-8143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	05/21/2026

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