1932914371 NPI number — ALEXANDER WILLIAM SULLIVAN MSW

Table of content: ALEXANDER WILLIAM SULLIVAN MSW (NPI 1932914371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932914371 NPI number — ALEXANDER WILLIAM SULLIVAN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
ALEXANDER
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
ALEC
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932914371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7071 SANDPIPER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49024-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-547-9730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5320 HOLIDAY TER STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49009-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-459-1512
Provider Business Practice Location Address Fax Number:
269-459-1151
Provider Enumeration Date:
02/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6851116184 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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