Provider Demographics
NPI:1093496507
Name:SLAGENWEIT, ALICIANA
Entity Type:Individual
Prefix:
First Name:ALICIANA
Middle Name:
Last Name:SLAGENWEIT
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 1:416 S REGESTER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2425
Mailing Address - Country:US
Mailing Address - Phone:816-772-3857
Mailing Address - Fax:
Practice Address - Street 1:7801 YORK RD STE 224
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7448
Practice Address - Country:US
Practice Address - Phone:410-733-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician