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NPI Code Detail

MEDICARE: MS. KERRY SULLIVAN LCSW

MEDICARE: MS. KERRY SULLIVAN 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
11041C0700XClinical Social Worker149013013IL

General Provider Information

NPI Number : 1205094661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KERRY SULLIVAN LCSW
Provider Business Mailing Address
First Line : 645 N MICHIGAN AVE STE 803
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5123
Country : US
Telephone Number : 312-217-2248
Fax Number :
Provider Business Practice Location Address
First Line : 645 N MICHIGAN AVE STE 803
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5123
Country : US
Telephone Number : 312-217-2248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2008
Last Update Date : 07/21/2022

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Directions to “ MS. KERRY SULLIVAN LCSW” Practice Location

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