Provider Demographics
NPI:1427180769
Name:SLATER, ILENE V (BA)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:V
Last Name:SLATER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23114 ERIEL AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3156
Mailing Address - Country:US
Mailing Address - Phone:310-433-9943
Mailing Address - Fax:
Practice Address - Street 1:11315 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3007
Practice Address - Country:US
Practice Address - Phone:310-537-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)