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General NPI Number Information
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NPI Number | 1073819603
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Entity Type | Individual
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Provider Name | LISA SALAZAR
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Gender | Female
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Dates
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Enumeration Date | 01/29/2011
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 7424 SHADELAND STATION WAY
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3925
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Country | US
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Telephone | 317-288-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 7209 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2021
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Country | US
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Telephone | 317-288-7606
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22005435A
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License Number State | IN
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