Provider Demographics
NPI:1154568202
Name:SALEK, MAHSA MOEENI (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAHSA
Middle Name:MOEENI
Last Name:SALEK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 S VINEYARD STE 128
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6882
Mailing Address - Country:US
Mailing Address - Phone:480-813-4886
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD STE 128
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6882
Practice Address - Country:US
Practice Address - Phone:480-813-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 1706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ810764Medicaid