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General NPI Number Information
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NPI Number | 1598270829
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Entity Type | Individual
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Provider Name | PETRITA LAVERNE SALAZAR LCPC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 526 S BUREAU VALLEY PKWY STE B
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City | PRINCETON
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State | IL
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Zip | 61356-2066
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Country | US
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Telephone | 815-875-4548
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Fax | 815-875-8602
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | PRINCETON
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State | IL
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Zip | 61356-0535
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Country | US
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Telephone | 815-875-4548
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Fax | 815-875-8602
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180006442
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License Number State | IL
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