Provider Demographics
NPI:1952122723
Name:SULLIVAN, KATHRINE MARIE (LSW)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S FRY ST
Mailing Address - Street 2:
Mailing Address - City:JASONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47438-1306
Mailing Address - Country:US
Mailing Address - Phone:812-699-5548
Mailing Address - Fax:
Practice Address - Street 1:1378 S STATE ROAD 46 STE A
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9787
Practice Address - Country:US
Practice Address - Phone:812-877-3310
Practice Address - Fax:833-451-2225
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012638A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker