Provider Demographics
NPI:1457859639
Name:SALLAS, KATHERINE MAE (174H00000X HEALTH ED)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MAE
Last Name:SALLAS
Suffix:
Gender:F
Credentials:174H00000X HEALTH ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 BLACK OAK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9501
Mailing Address - Country:US
Mailing Address - Phone:541-955-5519
Mailing Address - Fax:
Practice Address - Street 1:500 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5554
Practice Address - Country:US
Practice Address - Phone:541-955-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator