Provider Demographics
NPI:1770823171
Name:SALTARELLO, LEANNA MARIE
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:SALTARELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 JONES RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4829
Mailing Address - Country:US
Mailing Address - Phone:503-999-8731
Mailing Address - Fax:
Practice Address - Street 1:401 RATCLIFF DR SE
Practice Address - Street 2:SUITE 130
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4581
Practice Address - Country:US
Practice Address - Phone:503-999-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist