Provider Demographics
NPI:1851025787
Name:SALAZAR, MERISA S
Entity Type:Individual
Prefix:
First Name:MERISA
Middle Name:S
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 PORTAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9315
Mailing Address - Country:US
Mailing Address - Phone:330-479-6633
Mailing Address - Fax:330-775-7887
Practice Address - Street 1:901 TUSCARAWAS ST E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3152
Practice Address - Country:US
Practice Address - Phone:330-479-6633
Practice Address - Fax:330-775-7887
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22037171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2203717OtherMEDICAL MUTUAL
OHI.2203717OtherBCBS