Provider Demographics
NPI:1841494960
Name:JASPER, SALLY ANN (LICSW)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:JASPER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:27 FARLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5916
Mailing Address - Country:US
Mailing Address - Phone:603-880-1636
Mailing Address - Fax:
Practice Address - Street 1:1555 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1203
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical