1770509960 NPI number — MS. MICHELLE M SALOIS LCSW

Table of content: MS. MICHELLE M SALOIS LCSW (NPI 1770509960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770509960 NPI number — MS. MICHELLE M SALOIS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALOIS
Provider First Name:
MICHELLE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770509960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 ABBOTT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63143-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-993-8818
Provider Business Mailing Address Fax Number:
314-983-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 MANCHESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63143-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-993-8818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  140-010352 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 002117 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6280365 . This is a "UBH CLAIMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000604312SAL . This is a "MERCY HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 155294 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A4004610 . This is a "VALUE BEHAVIORAL HEALTH R" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: SALO3613 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 155294 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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