Healthcare Provider Details

I. General information

NPI: 1750898110
Provider Name (Legal Business Name): AIMEE SULLIVAN BIBB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CHAD DRIVE
EUGENE OR
97405
US

IV. Provider business mailing address

3555 CHAD DRIVE
EUGENE OR
97405
US

V. Phone/Fax

Practice location:
  • Phone: 541-037-8143
  • Fax:
Mailing address:
  • Phone: 907-957-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13564
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: