Provider Demographics
NPI:1578942355
Name:SLATE, ANITA H (HIS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:H
Last Name:SLATE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JANE JACOBS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6306
Mailing Address - Country:US
Mailing Address - Phone:828-456-6666
Mailing Address - Fax:828-456-8666
Practice Address - Street 1:15 JANE JACOBS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6306
Practice Address - Country:US
Practice Address - Phone:828-456-6666
Practice Address - Fax:828-456-8666
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1247237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist