Provider Demographics
NPI:1710104732
Name:JANSSEN, SALLY A (CST)
Entity Type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:A
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:SUITE 240 WEST
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3496
Mailing Address - Country:US
Mailing Address - Phone:920-731-8131
Mailing Address - Fax:
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:SUITE 240 WEST
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3496
Practice Address - Country:US
Practice Address - Phone:920-731-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist