Provider Demographics
NPI:1265558456
Name:SLATER, RICHARD (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SLATER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 MEETINGHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8243
Mailing Address - Country:US
Mailing Address - Phone:412-651-4727
Mailing Address - Fax:
Practice Address - Street 1:352 EAST CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2591
Practice Address - Country:US
Practice Address - Phone:704-663-3448
Practice Address - Fax:704-660-5158
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000114L235Z00000X
NC10186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL000114LOtherSTATE LICENSE NO
NC10186OtherLICENSE