Provider Demographics
NPI:1619162351
Name:SALAS, ROSA E (LMFT PHD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:E
Last Name:SALAS
Suffix:
Gender:F
Credentials:LMFT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 WINFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4023
Mailing Address - Country:US
Mailing Address - Phone:630-282-4884
Mailing Address - Fax:630-791-0864
Practice Address - Street 1:4320 WINFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-4023
Practice Address - Country:US
Practice Address - Phone:630-282-4884
Practice Address - Fax:630-791-0864
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2251106H00000X
IL166001186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL166001186OtherIDFPR