Provider Demographics
NPI:1659005007
Name:SALADA, KELLY ANNE (LISW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:SALADA
Suffix:
Gender:
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 PATTERSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4343
Mailing Address - Country:US
Mailing Address - Phone:888-648-9355
Mailing Address - Fax:888-648-9355
Practice Address - Street 1:453 PATTERSON RD STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4343
Practice Address - Country:US
Practice Address - Phone:888-648-9355
Practice Address - Fax:888-648-9355
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.25062271041C0700X
OHS.2208189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0003103Medicaid