Most Relevant Information
Provider Data
| NPI Number: | 1003038753 |
| Provider Name: | TIM D SULLIVAN MSW, LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | SW 003553 |
Most Important Dates
| Enumeration Date: | 05/03/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
229 RIDGEWOOD AVE
APARTMENT 112
MINNEAPOLIS
MN
554033554
Practice Location Phone/Fax
| Phone: | 6126007169 |
| Fax: |
Provider Mailing Location
229 RIDGEWOOD AVE
APARTMENT 112
MINNEAPOLIS
MN
554033554
Provider Mailing Phone/Fax
| Phone: | 6126007169 |
| Fax: |