Provider Demographics
NPI:1104712397
Name:SALAS GONZALEZ, GRICELDA
Entity type:Individual
Prefix:
First Name:GRICELDA
Middle Name:
Last Name:SALAS GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 ELAINE PL N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3698
Mailing Address - Country:US
Mailing Address - Phone:614-931-1040
Mailing Address - Fax:
Practice Address - Street 1:4011 ELAINE PL N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3698
Practice Address - Country:US
Practice Address - Phone:740-870-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child