Provider Demographics
NPI:1811344450
Name:SLAGLE, ROGER MILTON (MFA LCSW)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:MILTON
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:MFA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 SAVANNAH WAY
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9308
Mailing Address - Country:US
Mailing Address - Phone:530-646-7778
Mailing Address - Fax:
Practice Address - Street 1:999 MISSION DE ORO DR STE 103
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003
Practice Address - Country:US
Practice Address - Phone:530-605-0189
Practice Address - Fax:530-605-4428
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW108851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical