Provider Demographics
NPI:1023548377
Name:SLATER, MALORY PAIGE (LMSW)
Entity Type:Individual
Prefix:
First Name:MALORY
Middle Name:PAIGE
Last Name:SLATER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MALORY
Other - Middle Name:PAIGE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-934-3649
Practice Address - Street 1:4802 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8413
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-934-3649
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8335-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical