Serena D Sullivan | Portland, OR • PECOS Search

Serena D Sullivan

Counselor

Behavioral Health & Social Service Providers

11035 NE Sandy Blvd, Portland, OR 97220-2553

PECOS Enrollment

Based on the most recent information from CMS, provider Serena D Sullivan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1164857173
Provider Type
Individual
Full Name
Sullivan, Serena D
Gender
Female

Sole Proprietor
Yes
Enumeration Date
9/10/2013
Last Updated
7/29/2016

Contact Information

Practice Location

11035 NE Sandy Blvd, Portland, OR 97220-2553

Unlisted Fax

Mailing Location

11035 NE Sandy Blvd, Portland, OR 97220-2553

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer