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NPI Code Detail

MEDICARE: KATHLEEN ANN SULLIVAN LICSW

MEDICARE: KATHLEEN ANN SULLIVAN LICSW
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 Worker13480MN

General Provider Information

NPI Number : 1467574715
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ANN SULLIVAN LICSW
Provider Business Mailing Address
First Line : 3211 14TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 621 W LAKE ST STE 350
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2952
Country : US
Telephone Number : 612-979-2276
Fax Number : 612-925-0427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 10/22/2025

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Directions to “ KATHLEEN ANN SULLIVAN LICSW” Practice Location

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