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General NPI Number Information
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NPI Number | 1063210300
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Entity Type | Individual
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Provider Name | JESUS SALAZAR MSW, LSW
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Gender | Male
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 850 S MCHENRY AVE STE A
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7442
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Country | US
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Telephone | 815-455-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 529 FREMONT ST
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City | WOODSTOCK
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State | IL
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Zip | 60098-4066
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Country | US
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Telephone | 217-220-7479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.114970
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License Number State | IL
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