Provider Demographics
NPI:1922188739
Name:SULLIVAN, KRISANN WEBER (MPS, CPC, ATR)
Entity Type:Individual
Prefix:MRS
First Name:KRISANN
Middle Name:WEBER
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MPS, CPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3631
Mailing Address - Country:US
Mailing Address - Phone:308-440-1483
Mailing Address - Fax:
Practice Address - Street 1:3315 AVENUE E
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3631
Practice Address - Country:US
Practice Address - Phone:308-440-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE897101YP2500X
NC90-040221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist