Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY18300 | CA |
N | 103T00000X | Psychologist | PSY18300 | CA |
Y | 103G00000X | Clinical Psychologist | 1867 | OR |
Y | 103TC0700X | Clinical Psychologist | 1867 | OR |
NPI | 1013925148 |
---|---|
Provider Name | Amy Lynn Salazar |
First Address | Gresham, OR 97030-0510 |
Second Address | Troutdale, OR 97060-2093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 26/12/2017 |