Provider Demographics
NPI:1164944922
Name:SALTER, CAROLINE SUSANNAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUSANNAH
Last Name:SALTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:GOVIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8332 N DICKENS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3020
Mailing Address - Country:US
Mailing Address - Phone:818-395-7873
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2411
Practice Address - Country:US
Practice Address - Phone:503-297-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1093165623Medicaid