Provider Demographics
NPI:1225553381
Name:SALATA, KATHLEEN MARIANN BARBARA
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIANN BARBARA
Last Name:SALATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16158 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2228
Mailing Address - Country:US
Mailing Address - Phone:734-953-9216
Mailing Address - Fax:
Practice Address - Street 1:16158 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2228
Practice Address - Country:US
Practice Address - Phone:734-953-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist