Healthcare Provider Details

I. General information

NPI: 1053236737
Provider Name (Legal Business Name): MARY SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

315 E BUSINESS LOOP 70
COLUMBIA MO
65201-3907
US

IV. Provider business mailing address

8 N KEENE ST APT H48
COLUMBIA MO
65201-6683
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-2642
  • Fax:
Mailing address:
  • Phone: 913-660-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2019021873
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: