Provider Demographics
NPI:1629282686
Name:SALAZAR, DONNA JEAN (M ED, LBA, LISAC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:M ED, LBA, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3010
Mailing Address - Country:US
Mailing Address - Phone:520-840-0697
Mailing Address - Fax:520-635-5331
Practice Address - Street 1:705 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4034
Practice Address - Country:US
Practice Address - Phone:520-840-0697
Practice Address - Fax:520-635-5331
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11747101YA0400X
AZBEH-000773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)