Provider Demographics
NPI:1184697427
Name:SALTER, JOHN M (PSYD LP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SALTER
Suffix:
Gender:M
Credentials:PSYD LP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7172
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:8550 HUDSON BLVD
Practice Address - Street 2:HEALTHPARTNERS REGIONS BEHAVIORAL HEALTH-WOODBURY
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8706
Practice Address - Country:US
Practice Address - Phone:651-254-8580
Practice Address - Fax:651-730-1700
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN4324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN882972100Medicaid
680001611Medicare ID - Type Unspecified