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General NPI Number Information
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NPI Number | 1477476711
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Entity Type | Organization
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Legal Business Name | SULLIVANT AVENUE COMMUNITY SCHOOL
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 3435 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43204-1103
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Country | US
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Telephone | 614-308-5991
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43204-1103
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Country | US
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Telephone | 614-308-5991
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Fax |
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Authorized Official
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Title or Position | MSP CONSULTANT
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Name | SUSAN BOLLIN
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Credential |
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Telephone | 419-346-9651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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