Provider Demographics
NPI:1619151347
Name:SALCEDO, SHARON B (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:B
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:B
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:321 N FLORIDA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2951
Mailing Address - Country:US
Mailing Address - Phone:985-373-4446
Mailing Address - Fax:
Practice Address - Street 1:321 N FLORIDA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2951
Practice Address - Country:US
Practice Address - Phone:985-373-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist