Provider Demographics
NPI:1619269040
Name:SLATER, JENNIFER DARLENE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DARLENE
Last Name:SLATER
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 1:18 KARA CT
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9078
Mailing Address - Country:US
Mailing Address - Phone:309-242-7051
Mailing Address - Fax:
Practice Address - Street 1:18 KARA CT
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:IL
Practice Address - Zip Code:61732-9078
Practice Address - Country:US
Practice Address - Phone:309-242-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker