Doctor Name: | SALLY ANN TIMMONS |
NPI Number: | 1114952397 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, RN |
License Number: | 34004910A |
Business Practice Address: | 120 Sagamore Pkwy W West Lafayette, IN - 479061569 |
Business Phone Number: | 7654046431 |
Business Fax Number: | 7654777843 |
Mailing Address: | 1805 Skyline Rd, LAFAYETTE |
State: | IN |
Postal Code: | 479055591 |
Phone Number: | 7654749612 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2006 |
NPI Last Update Date: | 11/15/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 34004910A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |