Provider Demographics
NPI:1932282506
Name:SLAVICS, KATHRYNE E (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:E
Last Name:SLAVICS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHRYNE
Other - Middle Name:E
Other - Last Name:WENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12805 HWY 55
Mailing Address - Street 2:STE. 211
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3859
Mailing Address - Country:US
Mailing Address - Phone:763-550-9005
Mailing Address - Fax:
Practice Address - Street 1:12805 HWY 55
Practice Address - Street 2:STE. 211
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3859
Practice Address - Country:US
Practice Address - Phone:763-550-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health