Provider Demographics
NPI:1336245059
Name:SLAUGHTER, DORISA ANN (MSW, CSW)
Entity Type:Individual
Prefix:MS
First Name:DORISA
Middle Name:ANN
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SHUMARD OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1076
Mailing Address - Country:US
Mailing Address - Phone:859-255-6760
Mailing Address - Fax:
Practice Address - Street 1:504 SHUMARD OAK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1076
Practice Address - Country:US
Practice Address - Phone:859-255-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3623171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor