Provider Demographics
NPI:1710016563
Name:SALUSOVA, KELLY JOANNE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JOANNE
Last Name:SALUSOVA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:JOANNE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1018 NE REGAN HILL LOOP
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-9373
Mailing Address - Country:US
Mailing Address - Phone:503-902-1446
Mailing Address - Fax:503-397-5373
Practice Address - Street 1:1018 NE REGAN HILL LOOP
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9373
Practice Address - Country:US
Practice Address - Phone:503-902-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional