Provider Demographics
NPI:1831395144
Name:SULLIVAN, DELORES SWIGERT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:SWIGERT
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DELORES
Other - Middle Name:SWIGERT
Other - Last Name:TELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:553 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138
Mailing Address - Country:US
Mailing Address - Phone:503-916-8511
Mailing Address - Fax:
Practice Address - Street 1:564 PACIFIC WAY
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138
Practice Address - Country:US
Practice Address - Phone:503-741-5923
Practice Address - Fax:503-274-7846
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR40471041C0700X
ORL85391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical