MEDICARE: DR. JENNI LYNN SALATA PH.D.

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	103G00000X	Clinical Neuropsychologist	25982	CA
2	103TC0700X	Clinical Psychologist	25982	CA

General Provider Information

NPI Number	:	1679813794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNI LYNN SALATA PH.D.

Provider Business Mailing Address
First Line	:	23632 CALABASAS RD STE 201
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1737
Country	:	US
Telephone Number	:	805-379-4939
Fax Number	:

Provider Business Practice Location Address
First Line	:	23632 CALABASAS RD STE 201
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1737
Country	:	US
Telephone Number	:	818-394-0750
Fax Number	:

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

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	11/18/2025

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