Provider Demographics
NPI:1639843386
Name:HATTON, SALLY RENEE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:RENEE
Last Name:HATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 STARRET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3993
Mailing Address - Country:US
Mailing Address - Phone:740-687-0042
Mailing Address - Fax:
Practice Address - Street 1:106 STARRET ST STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3993
Practice Address - Country:US
Practice Address - Phone:740-687-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00219701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical