Provider Demographics
NPI:1083481451
Name:SULLIVAN, SYLVESTER L (APSW)
Entity Type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:APSW
Other - Prefix:MR
Other - First Name:SYLVESTER
Other - Middle Name:L
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APSW
Mailing Address - Street 1:571 BRAUND ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8556
Mailing Address - Country:US
Mailing Address - Phone:608-785-7000
Mailing Address - Fax:608-785-7477
Practice Address - Street 1:571 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-792-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134614104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker