Provider Demographics
NPI:1679813794
Name:SALATA, JENNI LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNI
Middle Name:LYNN
Last Name:SALATA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNISON
Other - Middle Name:LYNN
Other - Last Name:SALATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4766 PARK GRANADA STE 202
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3341
Mailing Address - Country:US
Mailing Address - Phone:805-379-4939
Mailing Address - Fax:
Practice Address - Street 1:4766 PARK GRANADA STE 202
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3341
Practice Address - Country:US
Practice Address - Phone:805-379-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25982103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist