Provider Demographics
NPI:1326457177
Name:SALLEY, CLARE MARIE (BSC (HONS))
Entity Type:Individual
Prefix:MS
First Name:CLARE
Middle Name:MARIE
Last Name:SALLEY
Suffix:
Gender:F
Credentials:BSC (HONS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 WATERMAN BLVD
Mailing Address - Street 2:UNIT 31
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112
Mailing Address - Country:US
Mailing Address - Phone:857-225-3961
Mailing Address - Fax:
Practice Address - Street 1:5673 WATERMAN BLVD
Practice Address - Street 2:UNIT 31
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112
Practice Address - Country:US
Practice Address - Phone:857-225-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014013953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist