MEDICARE: MRS. SALLY A CONWAY MS CCC-SLP, NHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2253-154	WI

General Provider Information

NPI Number	:	1104103431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY A CONWAY MS CCC-SLP, NHA

Provider Business Mailing Address
First Line	:	200880 CANOPY LN
Second Line	:
City	:	ROSHOLT
State	:	WI
Zip	:	54473-6705
Country	:	US
Telephone Number	:	715-439-3084
Fax Number	:

Provider Business Practice Location Address
First Line	:	200880 CANOPY LN
Second Line	:
City	:	ROSHOLT
State	:	WI
Zip	:	54473-6705
Country	:	US
Telephone Number	:	715-439-3084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	09/28/2025

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