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General NPI Number Information
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NPI Number | 1235921404
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Entity Type | Individual
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Provider Name | SANDRA L SALAS LPC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 3801 S CENTRAL AVE
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City | CICERO
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State | IL
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Zip | 60804-4398
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Country | US
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Telephone | 708-908-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 EAST AVE
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City | BERWYN
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State | IL
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Zip | 60402-2638
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Country | US
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Telephone | 708-908-0855
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.017698
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License Number State | IL
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