Provider Demographics
NPI:1205072717
Name:SALATIN, AMANDA GRELLA (LCSW, LCAC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GRELLA
Last Name:SALATIN
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W KIRKWOOD AVE STE 249
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-0004
Mailing Address - Country:US
Mailing Address - Phone:317-902-9550
Mailing Address - Fax:
Practice Address - Street 1:101 W KIRKWOOD AVE STE 249
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-0004
Practice Address - Country:US
Practice Address - Phone:317-902-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005443A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical