Provider Demographics
NPI:1750058939
Name:SAUNDERS, SALLY PHILLIPS (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:PHILLIPS
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5054
Mailing Address - Country:US
Mailing Address - Phone:540-389-0130
Mailing Address - Fax:
Practice Address - Street 1:616 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5064
Practice Address - Country:US
Practice Address - Phone:919-618-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist