Healthcare Provider Details

I. General information

NPI: 1063238384
Provider Name (Legal Business Name): AMBER LORETTA SALUTRIC M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

IV. Provider business mailing address

16536 W LANFEAR DR
LOCKPORT IL
60441-4742
US

V. Phone/Fax

Practice location:
  • Phone: 512-377-6318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number61547962
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18124
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146017382
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0006901
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: