Provider Demographics
NPI:1811599657
Name:SLAUGHTER, SANDRA JEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:SLAUGHTER
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 1:3151 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9079
Mailing Address - Country:US
Mailing Address - Phone:330-221-3607
Mailing Address - Fax:
Practice Address - Street 1:3151 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9079
Practice Address - Country:US
Practice Address - Phone:330-221-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide