Provider Demographics
NPI:1043831126
Name:QUILLIGAN, SALLY STROUD (HIS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:STROUD
Last Name:QUILLIGAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:MARIE
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:2825 BURNET AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2426
Mailing Address - Country:US
Mailing Address - Phone:513-221-0527
Mailing Address - Fax:513-221-8014
Practice Address - Street 1:2825 BURNET AVE STE 330
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-8014
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03421237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist