Provider Demographics
NPI:1902437379
Name:SULLIVAN, DONNA-SUE (COMS, CLVT)
Entity Type:Individual
Prefix:
First Name:DONNA-SUE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:COMS, CLVT
Other - Prefix:
Other - First Name:DONNA-SUE
Other - Middle Name:
Other - Last Name:SULLIVAN-ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COMS, CLVT
Mailing Address - Street 1:115 VITAL ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5440
Mailing Address - Country:US
Mailing Address - Phone:225-278-3361
Mailing Address - Fax:
Practice Address - Street 1:115 VITAL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5440
Practice Address - Country:US
Practice Address - Phone:225-278-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50402255R0406X
LA15242255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699839944OtherLOUISIANA ASSOCIATION FOR THE BLIND