DEBORAH JEAN SULLIVAN LADC NPI 1902065964

NPI Information

NPI: 1902065964
Provider Name: DEBORAH JEAN SULLIVAN, LADC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1215 SE 7TH AVE
GRAND RAPIDS, MN
ZIP 55744
Phone: (218) 313-1338
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Deborah Jean Sullivan, LADC is an addiction (substance use disorder) counselor in Grand Rapids, MN. Deborah Jean Sullivan, LADC NPI is 1902065964. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1215 SE 7TH AVE
GRAND RAPIDS, MN
ZIP 55744-201
Phone: (218) 313-1338

The enumeration date for this NPI number is 6/5/2008 and was last updated on 6/5/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	302323	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	188856100	OTHER	MINNESOTA	IMCARE
2	8199PNO	OTHER	MINNESOTA	BCBS
3	84-10374	OTHER	MINNESOTA	UBH/MEDICA
4	1021875	OTHER	MINNESOTA	PREFERRED ONE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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