Provider Demographics
NPI:1831386713
Name:LACROIX, SALLY (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:LACROIX
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N9654 COUNTY RD N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7272
Mailing Address - Country:US
Mailing Address - Phone:920-840-3033
Mailing Address - Fax:920-882-4009
Practice Address - Street 1:N9654 COUNTY RD N
Practice Address - Street 2:SUITE 3
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7272
Practice Address - Country:US
Practice Address - Phone:920-840-3033
Practice Address - Fax:920-882-4009
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1831386713OtherNPI