Provider Demographics
NPI:1447144977
Name:CHRISMAN, SALLY JO (RAC)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JO
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 VICTORY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-7789
Mailing Address - Country:US
Mailing Address - Phone:209-312-3184
Mailing Address - Fax:
Practice Address - Street 1:416 CORSON AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5408
Practice Address - Country:US
Practice Address - Phone:209-550-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)