Provider Demographics
NPI:1801603212
Name:SLAUGHTER, JEKAYLA ANTOINETTE
Entity type:Individual
Prefix:
First Name:JEKAYLA
Middle Name:ANTOINETTE
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 WHITCOMB ST APT C
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4573
Mailing Address - Country:US
Mailing Address - Phone:219-902-1569
Mailing Address - Fax:
Practice Address - Street 1:7618 WHITCOMB ST APT C
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4573
Practice Address - Country:US
Practice Address - Phone:219-902-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-370319106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician