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General NPI Number Information
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NPI Number | 1952122723
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Entity Type | Individual
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Provider Name | KATHRINE MARIE SULLIVAN LSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1378 S STATE ROAD 46 STE A
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9787
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Country | US
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Telephone | 812-877-3310
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Fax | 833-451-2225
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Provider Business Mailing Address
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Address Line | 106 S FRY ST
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City | JASONVILLE
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State | IN
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Zip | 47438-1306
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Country | US
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Telephone | 812-699-5548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33012638A
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License Number State | IN
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