Individual
MRS. SALLY W IVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPE
Contact information
Practice address
700 MOUNT HOPE AVE, SUITE 680 EVERGREEN WOODS, BANGOR, ME 04401-5691
(207) 942-9305
(207) 990-3954
Mailing address
700 MOUNT HOPE AVE, SUITE 680 EVERGREEN WOODS, BANGOR, ME 04401-5691
(207) 942-9305
(207) 990-3954
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
PE662
ME
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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