Healthcare Provider Details

I. General information

NPI: 1447308598
Provider Name (Legal Business Name): SALLIE ANNELLE NORQUIST PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BIRDSEYE GLN
VERONA NJ
07044-2304
US

IV. Provider business mailing address

29 BIRDSEYE GLN
VERONA NJ
07044-2304
US

V. Phone/Fax

Practice location:
  • Phone: 201-659-3060
  • Fax:
Mailing address:
  • Phone: 201-659-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSIO2371
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: