Provider Demographics
NPI:1558933515
Name:DONNELLY, SALLY (MS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILLMONT ST APT D
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3502
Mailing Address - Country:US
Mailing Address - Phone:203-906-9596
Mailing Address - Fax:
Practice Address - Street 1:220 BEAR HILL RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1004
Practice Address - Country:US
Practice Address - Phone:781-790-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty