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General NPI Number Information
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NPI Number | 1760711683
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Entity Type | Individual
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Provider Name | ELLIOT DAVID SALK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/24/2009
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Last Update Date | 12/24/2009
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Provider Practice Location Address
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Address Line | 3509 E SHEA BLVD #117
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City | PHOENIX
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State | AZ
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Zip | 85028-3336
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Country | US
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Telephone | 602-569-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 4757 E GREENWAY RD #107-B, PMB 282
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City | PHOENIX
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State | AZ
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Zip | 85032-8513
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Country | US
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Telephone | 602-679-5481
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1176
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301001675
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License Number State | MI
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