Provider Demographics
NPI:1528384658
Name:SLAUGHTER, ALPHONSO J JR (MS)
Entity Type:Individual
Prefix:MR
First Name:ALPHONSO
Middle Name:J
Last Name:SLAUGHTER
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GRAYMOOR LN
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1214
Mailing Address - Country:US
Mailing Address - Phone:708-612-2590
Mailing Address - Fax:
Practice Address - Street 1:88 GRAYMOOR LN
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1214
Practice Address - Country:US
Practice Address - Phone:708-612-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004828A235Z00000X
IL146006740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist