Provider Demographics
NPI:1821358987
Name:SLATTERY, THOMAS LLOYD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LLOYD
Last Name:SLATTERY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S ELDORADO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6071
Mailing Address - Country:US
Mailing Address - Phone:309-310-4636
Mailing Address - Fax:309-588-4115
Practice Address - Street 1:808 S ELDORADO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6071
Practice Address - Country:US
Practice Address - Phone:309-310-4636
Practice Address - Fax:309-588-4115
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist