| Doctor Name: | DR. LAURIE ANN SULLIVAN-SAKAEDA |
| NPI Number: | 1811230394 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 355022-2501 |
| Business Practice Address: | 354 W Wrathall Ln Grantsville, UT - 840299375 |
| Business Phone Number: | 8019155019 |
| Business Fax Number: | 4358840868 |
| Mailing Address: | 354 W Wrathall Ln, GRANTSVILLE |
| State: | UT |
| Postal Code: | 840299375 |
| Phone Number: | 8019155019 |
| Fax Number: | 4358840868 |
| NPI Enumeration Date: | 04/03/2013 |
| NPI Last Update Date: | 04/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 355022-2501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |