Provider Demographics
NPI:1902927684
Name:SALES, SALLY ANN (MA, CPRP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:SALES
Suffix:
Gender:F
Credentials:MA, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3110
Mailing Address - Country:US
Mailing Address - Phone:612-327-0214
Mailing Address - Fax:
Practice Address - Street 1:5510 W BROADWAY AVE
Practice Address - Street 2:SUITE 112A
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3577
Practice Address - Country:US
Practice Address - Phone:612-752-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor