Provider Demographics
NPI:1962042218
Name:SLATER, MALIK
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:SLATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12729 NORTHUP WAY, SUITE 9
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:866-727-8274
Mailing Address - Fax:800-459-4245
Practice Address - Street 1:12729 NORTHUP WAY, SUITE 9
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:866-727-8274
Practice Address - Fax:800-459-4245
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALABA.AB.61340605106E00000X
WACB61032701106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst