Provider Demographics
NPI:1790306876
Name:HAMER, SALLY NELSON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:NELSON
Last Name:HAMER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3112
Mailing Address - Country:US
Mailing Address - Phone:307-202-2285
Mailing Address - Fax:
Practice Address - Street 1:2909 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3112
Practice Address - Country:US
Practice Address - Phone:307-202-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist