Provider Demographics
NPI:1992395750
Name:SALLADE, JACQUELINE CORINE (MS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CORINE
Last Name:SALLADE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2222
Mailing Address - Country:US
Mailing Address - Phone:717-715-5425
Mailing Address - Fax:
Practice Address - Street 1:2 PENN BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1403
Practice Address - Country:US
Practice Address - Phone:267-930-5094
Practice Address - Fax:215-844-5401
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist