Provider Demographics
NPI:1689797136
Name:SLATTERY, WILLIAM SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:SLATTERY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2584
Mailing Address - Country:US
Mailing Address - Phone:612-386-9682
Mailing Address - Fax:651-305-6071
Practice Address - Street 1:333 GRAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2584
Practice Address - Country:US
Practice Address - Phone:612-386-9682
Practice Address - Fax:651-305-6071
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4325103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling