Provider Demographics
NPI:1720574809
Name:WESSELDYK, SALLY ANN
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:WESSELDYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4706 TOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1012
Mailing Address - Country:US
Mailing Address - Phone:517-525-0892
Mailing Address - Fax:
Practice Address - Street 1:4706 TOLLAND AVE
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1012
Practice Address - Country:US
Practice Address - Phone:517-525-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3501004535237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist