Provider Demographics
NPI:1093014201
Name:SLATER, COURTNEY ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:SLATER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-2028
Mailing Address - Country:US
Mailing Address - Phone:515-262-7944
Mailing Address - Fax:
Practice Address - Street 1:4815 MAPLE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-2028
Practice Address - Country:US
Practice Address - Phone:515-262-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001961133V00000X
IL164005867133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered