Provider Demographics
NPI:1376927269
Name:SALZER, DESIREE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SALZER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11632 DARLING WAY
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8150
Mailing Address - Country:US
Mailing Address - Phone:512-736-6877
Mailing Address - Fax:
Practice Address - Street 1:11632 DARLING WAY
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8150
Practice Address - Country:US
Practice Address - Phone:512-736-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1-15-18225103K00000X
ORABA-B-10169685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst