Provider Demographics
NPI:1356443311
Name:SLAUGHTER, THERESA KIM (DTR)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KIM
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 FORD ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-4105
Mailing Address - Country:US
Mailing Address - Phone:412-469-1190
Mailing Address - Fax:
Practice Address - Street 1:7180 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1206
Practice Address - Country:US
Practice Address - Phone:412-365-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA818268136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered