Provider Demographics
NPI:1598116220
Name:SALAZAR, ASHLEY JEAN (BS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEAN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JEAN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7109
Mailing Address - Country:US
Mailing Address - Phone:815-756-8501
Mailing Address - Fax:815-756-5849
Practice Address - Street 1:631 S 1ST ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4117
Practice Address - Country:US
Practice Address - Phone:815-756-8501
Practice Address - Fax:815-756-5849
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474579189001Medicaid