Provider Demographics
NPI:1134410616
Name:STROUGH, SALLY W
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:W
Last Name:STROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 GREENVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2430
Mailing Address - Country:US
Mailing Address - Phone:315-492-4326
Mailing Address - Fax:
Practice Address - Street 1:725 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2395
Practice Address - Country:US
Practice Address - Phone:315-435-4202
Practice Address - Fax:315-435-4987
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist