Provider Demographics
NPI:1740070622
Name:SULLIVAN, LAUREN JOELLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JOELLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JOELLE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5040 CARROLL EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9537
Mailing Address - Country:US
Mailing Address - Phone:740-243-6627
Mailing Address - Fax:
Practice Address - Street 1:5040 CARROLL EASTERN RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9537
Practice Address - Country:US
Practice Address - Phone:740-243-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care