Provider Demographics
NPI:1922132919
Name:SALAS, TAMMY NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:NICOLE
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 N 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4647
Mailing Address - Country:US
Mailing Address - Phone:414-839-3494
Mailing Address - Fax:
Practice Address - Street 1:540 SHEPHERDS DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-8488
Practice Address - Country:US
Practice Address - Phone:262-306-8540
Practice Address - Fax:262-306-8451
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2360-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist