Individual
SALLY ANNE VAN LANEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MSSLP
Contact information
Practice address
101 N 2ND ST, RATON, NM 87740-3803
(505) 445-7090
Mailing address
14100 COUNTY ROAD 67.3, TRINIDAD, CO 81082-9536
(719) 859-3145
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3904
NM
Other
Enumeration date
04/19/2006
Last updated
07/08/2007
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