Active NPI
Dianne Lynn Sullivan, CSAC
- Addiction (Substance Use Disorder) Counselor
- Hayward, WI
National Provider Identifier
1942632997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1343-132
- Practice address
- 13380 W Trepania Rd
Hayward, WI 54843-2186 - Phone
- (715) 638-5111
- Fax
- (715) 634-6107
- NPI assigned
- Aug 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1343-132 | WI | Primary |
Addresses
Primary practice location
13380 W Trepania Rd
Hayward, WI 54843-2186
Mailing address
13380 W Trepania Rd
Hayward, WI 54843-2186
Phone (715) 638-5111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1343-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375315200000",
"number": "1942632997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13380 W TREPANIA RD",
"city": "HAYWARD",
"state": "WI",
"postal_code": "548432186",
"telephone_number": "715-638-5111",
"fax_number": "715-634-6107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13380 W TREPANIA RD",
"city": "HAYWARD",
"state": "WI",
"postal_code": "548432186",
"telephone_number": "715-638-5111",
"fax_number": "715-634-6107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "DIANNE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "CSAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-01",
"last_updated": "2013-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1343-132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.