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NPI Code Detail

MEDICARE: MICAH SALLUS ASW

MEDICARE: MICAH SALLUS ASW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerASW124959CA

General Provider Information

NPI Number : 1033097530
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAH SALLUS ASW
Provider Business Mailing Address
First Line : 15332 ANTIOCH ST # 564
Second Line :
City : PACIFIC PALISADES
State : CA
Zip : 90272-3603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 655 F ST STE A
Second Line :
City : ARCATA
State : CA
Zip : 95521-6366
Country : US
Telephone Number : 707-273-1998
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2025
Last Update Date : 08/22/2025

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Directions to “ MICAH SALLUS ASW” Practice Location

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