Provider Demographics
NPI:1295855203
Name:SALCIDO, LUIS JOEL (MSCCCSLP)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:JOEL
Last Name:SALCIDO
Suffix:
Gender:M
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:WINK
Mailing Address - State:TX
Mailing Address - Zip Code:79789-0637
Mailing Address - Country:US
Mailing Address - Phone:432-527-3880
Mailing Address - Fax:432-527-3505
Practice Address - Street 1:200 N ROSY DODD AVE.
Practice Address - Street 2:
Practice Address - City:WINK
Practice Address - State:TX
Practice Address - Zip Code:79789
Practice Address - Country:US
Practice Address - Phone:432-527-3505
Practice Address - Fax:432-527-3505
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19516OtherSTATE LICENSE NUMBER
TX756002793Medicaid