Provider Demographics
NPI:1235303942
Name:SALAZAR, MICHELLE (LISW-S)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DELONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:401 E. MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1736
Mailing Address - Country:US
Mailing Address - Phone:419-305-7214
Mailing Address - Fax:567-890-7214
Practice Address - Street 1:401 E. MARKET ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1736
Practice Address - Country:US
Practice Address - Phone:419-584-5123
Practice Address - Fax:567-890-7214
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007811-SUPV101YM0800X
OHI.0007811.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155813Medicaid