Provider Demographics
NPI:1578623823
Name:FETTERMAN, SALLY ANN (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:FETTERMAN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:KISSINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCCSLP
Mailing Address - Street 1:1825 S MOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608
Mailing Address - Country:US
Mailing Address - Phone:610-796-8705
Mailing Address - Fax:
Practice Address - Street 1:9 BRISTOL COURT
Practice Address - Street 2:THE CENTER FOR PEDIATRIC THERAPY INC
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-678-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SL002964L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist