Provider Demographics
NPI:1962653899
Name:SLAGER, RONALD D
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:SLAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5317
Mailing Address - Country:US
Mailing Address - Phone:269-324-0301
Mailing Address - Fax:269-324-2387
Practice Address - Street 1:1111 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5317
Practice Address - Country:US
Practice Address - Phone:269-324-0301
Practice Address - Fax:269-324-2387
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000656237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000656OtherSTATE HEARING AID DEALER LICENSE NO