Provider Demographics
NPI:1841748001
Name:SLONE, TARA (LLMSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SLONE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 FRASER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-7763
Mailing Address - Country:US
Mailing Address - Phone:269-760-6824
Mailing Address - Fax:
Practice Address - Street 1:1608 LAKE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3170
Practice Address - Country:US
Practice Address - Phone:269-760-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010997951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical