| Doctor Name: | SALLY ANNE VAN LANEN |
| NPI Number: | 1952366379 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSSLP |
| License Number: | 3904 |
| Business Practice Address: | 101 N 2nd St Raton, NM - 877403803 |
| Business Phone Number: | 5054457090 |
| Business Fax Number: | |
| Mailing Address: | 14100 County Road 67.3, TRINIDAD |
| State: | CO |
| Postal Code: | 810829536 |
| Phone Number: | 7198593145 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3904 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |