Provider Demographics
NPI:1972637742
Name:MEISENHEIMER, SALLY A
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:MEISENHEIMER
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 1:4 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5129
Mailing Address - Country:US
Mailing Address - Phone:518-562-0615
Mailing Address - Fax:518-561-9566
Practice Address - Street 1:4 CARDINAL CT
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5129
Practice Address - Country:US
Practice Address - Phone:518-562-0615
Practice Address - Fax:518-561-9566
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor