Provider Demographics
NPI:1255491197
Name:SALO, ANN A (PHD, ABPN)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:A
Last Name:SALO
Suffix:
Gender:F
Credentials:PHD, ABPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 N MESA ST STE 500
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4630
Mailing Address - Country:US
Mailing Address - Phone:915-581-6463
Mailing Address - Fax:915-581-2313
Practice Address - Street 1:6006 N MESA ST STE 500
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4630
Practice Address - Country:US
Practice Address - Phone:915-581-6463
Practice Address - Fax:915-581-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23377103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129969OtherVALUE OPTIONS
TX4360754OtherAETNA
TX742574940OtherTAX IDENTIFICATION NUMBER
TX031662201Medicaid
TX00A32LOtherBCBS
TX101505000OtherDEPARTMENT OF LABOR ID
TX00A32LMedicare ID - Type Unspecified
TX742574940OtherTAX IDENTIFICATION NUMBER