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General NPI Number Information
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NPI Number | 1992395750
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Entity Type | Individual
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Provider Name | JACQUELINE CORINE SALLADE MS
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Gender | Female
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 2 PENN BLVD STE 220
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1403
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Country | US
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Telephone | 267-930-5094
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Fax | 215-844-5401
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Provider Business Mailing Address
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Address Line | 441 E COLLEGE AVE
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2222
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Country | US
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Telephone | 717-715-5425
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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 | SL015323
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License Number State | PA
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