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General NPI Number Information
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NPI Number | 1821631888
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Entity Type | Individual
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Provider Name | JEFF SALT D.CLIN.PSY. BSC
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Gender | Male
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 3S140 BARKLEY AVE
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City | WARRENVILLE
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State | IL
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Zip | 60555-1505
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Country | US
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Telephone | 331-431-4006
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Fax |
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Provider Business Mailing Address
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Address Line | 142 S MONTCLAIR AVE
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City | GLEN ELLYN
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State | IL
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Zip | 60137-6357
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Country | US
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Telephone | 224-227-0497
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071007484
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License Number State | IL
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