Provider Demographics
NPI:1346332442
Name:SLATER, KRISTEN LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LYNN
Last Name:SLATER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 BIRCH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8113
Mailing Address - Country:US
Mailing Address - Phone:714-319-8041
Mailing Address - Fax:
Practice Address - Street 1:5015 BIRCH ST STE 115
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8113
Practice Address - Country:US
Practice Address - Phone:714-319-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical