Provider Demographics
NPI:1750151395
Name:SLAINTE CLINIC
Entity type:Organization
Organization Name:SLAINTE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APNP, PMHNP-BC
Authorized Official - Phone:920-944-8474
Mailing Address - Street 1:555 S INDUSTRIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2333
Mailing Address - Country:US
Mailing Address - Phone:920-944-8474
Mailing Address - Fax:
Practice Address - Street 1:555 S INDUSTRIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2333
Practice Address - Country:US
Practice Address - Phone:920-944-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty