Provider Demographics
NPI:1861772865
Name:SALLADE, MARRIE K (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MARRIE
Middle Name:K
Last Name:SALLADE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:OSTEEN
Mailing Address - State:FL
Mailing Address - Zip Code:32764-9461
Mailing Address - Country:US
Mailing Address - Phone:386-843-3006
Mailing Address - Fax:
Practice Address - Street 1:179 RABBIT RUN
Practice Address - Street 2:
Practice Address - City:OSTEEN
Practice Address - State:FL
Practice Address - Zip Code:32764-9461
Practice Address - Country:US
Practice Address - Phone:386-843-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-9657103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst