Provider Demographics
NPI:1467624742
Name:CYNTHIA G SLOCUM MSW LCSW PC
Entity Type:Organization
Organization Name:CYNTHIA G SLOCUM MSW LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-992-5646
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:76 S MAIN ST SUITE B
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554
Mailing Address - Country:US
Mailing Address - Phone:630-992-5646
Mailing Address - Fax:
Practice Address - Street 1:76 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-992-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty