Provider Demographics
NPI:1528293669
Name:SALAZAR, JANELLE ROSLYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:ROSLYNN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 MONTECITO CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3568
Mailing Address - Country:US
Mailing Address - Phone:505-310-3639
Mailing Address - Fax:
Practice Address - Street 1:4505 BALI CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2801
Practice Address - Country:US
Practice Address - Phone:505-292-7104
Practice Address - Fax:505-296-2183
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5216235Z00000X
NM4055235Z00000X
NMC-4824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid