Provider Demographics
NPI:1265579460
Name:SWEENEY, SALLY J
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:J
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:J
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW,LISW
Mailing Address - Street 1:503 TELESCOPE VW
Mailing Address - Street 2:304
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41076-2462
Mailing Address - Country:US
Mailing Address - Phone:859-441-4019
Mailing Address - Fax:859-581-4273
Practice Address - Street 1:519 LICKING PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-581-4273
Practice Address - Fax:859-581-4273
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health