Provider Demographics
NPI:1750110029
Name:SALO, TOBI (LLMSW)
Entity type:Individual
Prefix:
First Name:TOBI
Middle Name:
Last Name:SALO
Suffix:
Gender:X
Credentials:LLMSW
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:SALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:173 E OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1332
Mailing Address - Country:US
Mailing Address - Phone:586-275-8549
Mailing Address - Fax:
Practice Address - Street 1:1938 BURDETTE ST STE 107
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1982
Practice Address - Country:US
Practice Address - Phone:313-355-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851118453104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker