Provider Demographics
NPI:1336295732
Name:HUBBARD, SALLY A (MA)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WALLER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2915
Mailing Address - Country:US
Mailing Address - Phone:859-252-3170
Mailing Address - Fax:859-225-7155
Practice Address - Street 1:333 WALLER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2915
Practice Address - Country:US
Practice Address - Phone:859-252-3170
Practice Address - Fax:859-225-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0434237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter