Provider Demographics
NPI:1073758488
Name:NELSON, SALLY JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 RUBENSTEIN DR
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2321
Mailing Address - Country:US
Mailing Address - Phone:760-944-3520
Mailing Address - Fax:
Practice Address - Street 1:1816 RUBENSTEIN DR
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-2321
Practice Address - Country:US
Practice Address - Phone:760-944-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical