Provider Demographics
NPI:1013925148
Name:SALAZAR, AMY LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 E HISTORIC COLUMBIA RIVER HWY
Practice Address - Street 2:STE 208
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2093
Practice Address - Country:US
Practice Address - Phone:503-550-8587
Practice Address - Fax:503-491-8736
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18300103T00000X
OR1867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist