Healthcare Provider Details

I. General information

NPI: 1700110947
Provider Name (Legal Business Name): SALLY J VAHOVICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 S CHASE AVE
MILWAUKEE WI
53207-6407
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 414-934-6400
  • Fax:
Mailing address:
  • Phone: 602-248-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2508-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: