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General NPI Number Information
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NPI Number | 1760341770
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Entity Type | Organization
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Legal Business Name | KERRY SULLIVAN COUNSELING PLLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 142 BROOKERIDGE DR
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City | WATERLOO
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State | IA
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Zip | 50702-5702
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Country | US
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Telephone | 319-254-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 140 BROOKERIDGE DR
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City | WATERLOO
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State | IA
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Zip | 50702-5702
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Country | US
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Telephone | 319-254-5885
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | JEN WOLLUM
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Credential |
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Telephone | 712-363-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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