Latasha Sullivan

NPI #1083374789 in Clayton, Missouri

Provider Information

NPI Number: 1083374789
Entity Type: Individual
Name: Latasha Sullivan
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 21, 2021
Last Updated: Dec 21, 2021

Practice Location

Address: 7777 BONHOMME AVE STE 1800
City: Clayton
State: Missouri
ZIP Code: 63105-1931
Phone: (636) 202-0693

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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