Provider Demographics
NPI:1447804109
Name:SLEN, ANN ELISABETH
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELISABETH
Last Name:SLEN
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 1:1913 OMEE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7961
Mailing Address - Country:US
Mailing Address - Phone:260-348-7645
Mailing Address - Fax:
Practice Address - Street 1:1913 OMEE CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7961
Practice Address - Country:US
Practice Address - Phone:260-348-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000OtherINDIANA FIRST STEPS