Healthcare Provider Details

I. General information

NPI: 1861742934
Provider Name (Legal Business Name): EMILY SALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 10/28/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S COLORADO BLVD STE 20
DENVER CO
80246-8010
US

IV. Provider business mailing address

675 LAKEVIEW AVE
BIRMINGHAM MI
48009-3828
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001737
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: