Healthcare Provider Details

I. General information

NPI: 1588582456
Provider Name (Legal Business Name): LAUREN SALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 VALLEY ST
DAYTON OH
45404-2066
US

IV. Provider business mailing address

860 VALLEY ST
DAYTON OH
45404-2066
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3211
  • Fax:
Mailing address:
  • Phone: 937-641-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.2411036
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: