Provider Demographics
NPI:1720383243
Name:SLATER, ELLEN SCHLAFLY (LICSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SCHLAFLY
Last Name:SLATER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 ANTHONY PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6804
Mailing Address - Country:US
Mailing Address - Phone:206-459-6860
Mailing Address - Fax:
Practice Address - Street 1:1307 N 45TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6741
Practice Address - Country:US
Practice Address - Phone:206-459-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603095981041C0700X
WACG60120739101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical