Provider Demographics
NPI:1326719329
Name:SALATA, JODI A (ALMFT)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:A
Last Name:SALATA
Suffix:
Gender:F
Credentials:ALMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 DUNDEE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2432
Mailing Address - Country:US
Mailing Address - Phone:847-306-6477
Mailing Address - Fax:847-777-0563
Practice Address - Street 1:3000 DUNDEE RD STE 205
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2432
Practice Address - Country:US
Practice Address - Phone:847-306-6477
Practice Address - Fax:847-777-0563
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist