Provider Demographics
NPI:1780852392
Name:CHRISTIAN, SALLY ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 EL BANQUERO PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1132
Mailing Address - Country:US
Mailing Address - Phone:619-508-1711
Mailing Address - Fax:619-374-3169
Practice Address - Street 1:6818 EL BANQUERO PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1132
Practice Address - Country:US
Practice Address - Phone:619-508-1711
Practice Address - Fax:619-374-3169
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist