Provider Demographics
NPI:1417196247
Name:SALVAS, KENNETH R (EDD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:SALVAS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 WARD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6597
Mailing Address - Country:US
Mailing Address - Phone:386-424-1950
Mailing Address - Fax:
Practice Address - Street 1:5401 WARD LAKE DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6597
Practice Address - Country:US
Practice Address - Phone:386-424-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional