Provider Demographics
NPI:1184826653
Name:SULLIVAN, DENISE C
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 VAUGHN CT
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2036
Mailing Address - Country:US
Mailing Address - Phone:815-895-9441
Mailing Address - Fax:815-895-9441
Practice Address - Street 1:908 VAUGHN CT
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2036
Practice Address - Country:US
Practice Address - Phone:815-895-9441
Practice Address - Fax:815-895-9441
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist