Provider Demographics
NPI:1750417960
Name:SLATER, REBECCA ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:SLATER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4021
Mailing Address - Country:US
Mailing Address - Phone:903-593-2924
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR
Practice Address - Street 2:SUITE 137
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1629
Practice Address - Country:US
Practice Address - Phone:903-534-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX087671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS89NMedicare ID - Type UnspecifiedPROVIDER #