Provider Demographics
NPI:1396895223
Name:SLANGER, ELISSA L (PHD)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:L
Last Name:SLANGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W 2ND ST
Mailing Address - Street 2:#305
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5626
Mailing Address - Country:US
Mailing Address - Phone:775-352-5082
Mailing Address - Fax:530-587-0887
Practice Address - Street 1:888 W 2ND ST
Practice Address - Street 2:#305
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5626
Practice Address - Country:US
Practice Address - Phone:775-352-5082
Practice Address - Fax:530-587-0887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPYO 290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2616065Medicaid
NV2616065Medicaid