Individual
JILL E SALEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP
Contact information
Practice address
1415 SALEM ST, SUITE 102, LAFAYETTE, IN 47904-4100
(765) 742-1816
(765) 742-2557
Mailing address
1607 RAVINIA RD, WEST LAFAYETTE, IN 47906-2361
(765) 742-1826
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20041615A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200283590A
—
IN
Enumeration date
10/20/2006
Last updated
07/26/2010
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