Provider Demographics
NPI:1912419920
Name:PATTON, SALLY E
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:E
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:EILEEN
Other - Last Name:WAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0145
Mailing Address - Country:US
Mailing Address - Phone:307-321-1093
Mailing Address - Fax:
Practice Address - Street 1:207 SOUTH RIVER STREET
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331
Practice Address - Country:US
Practice Address - Phone:130-732-1109
Practice Address - Fax:307-321-1093
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker