Healthcare Provider Details

I. General information

NPI: 1073209771
Provider Name (Legal Business Name): MYRNA SALCIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W NEW INDIAN TRL
AURORA IL
60506-2494
US

IV. Provider business mailing address

708 N BRIDGE ST
YORKVILLE IL
60560-1105
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4452
  • Fax:
Mailing address:
  • Phone: 630-966-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: