Provider Demographics
NPI:1821481375
Name:JOHN SLIGHTAM MD INC.
Entity Type:Organization
Organization Name:JOHN SLIGHTAM MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SLIGHTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-824-5554
Mailing Address - Street 1:19987 1ST AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19987 1ST AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2400
Practice Address - Country:US
Practice Address - Phone:206-824-5554
Practice Address - Fax:206-824-5550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN SLIGHTAM MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-414-473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty