MEDICARE: MISS ISA M SALVADOR LMSW, LCSW

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
1	1041C0700X	Clinical Social Worker	1194846915	IL
2	1041C0700X	Clinical Social Worker	6801085624	MI

General Provider Information

NPI Number	:	1194846915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ISA M SALVADOR LMSW, LCSW

Provider Business Mailing Address
First Line	:	67 VERNIER RD
Second Line	:
City	:	GROSSE POINTE SHORES
State	:	MI
Zip	:	48236-1516
Country	:	US
Telephone Number	:	313-682-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-725-0841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	02/24/2024

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