Shanna Patricia Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7586-123 Issued in WI

Practice address

620 S 76TH St
Milwaukee, WI 53214-1599

Phone

(414) 453-1400

Fax

(414) 453-2538

NPI assigned

Jun 2, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1548580426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 S 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532141599",
            "telephone_number": "414-453-1400",
            "fax_number": "414-453-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532141599",
            "telephone_number": "414-453-1400",
            "fax_number": "414-453-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7950 N Port Washington Rd",
            "address_purpose": "LOCATION",
            "city": "Fox Point",
            "state": "WI",
            "postal_code": "532173131",
            "country_code": "US",
            "telephone_number": "414-253-1194",
            "fax_number": "414-540-1065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SHANNA",
        "middle_name": "PATRICIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7586-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083888382",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114192499",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Sullivan, DPM
• Julie Sullivan, M.D
• Katie Sullivan, MD
• Marcia Sullivan, NP
• Monica Sullivan, PA-C
• Stacey Allysun Sullivan, APNP
• Cecille G Sulman, MD
• Ali Faisal Sultan, MD
• Mutaz Idrees Sultan, MD
• Samir Sultan, DO

• Clinical Social Worker in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.