Provider Demographics
NPI:1508812298
Name:WALSH, SALLY A (MS, CCC-SLP)
Entity Type:Individual
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First Name:SALLY
Middle Name:A
Last Name:WALSH
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY (CS126)
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-222-6588
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY (CS126)
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-222-6588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZSLP0154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist