Provider Demographics
NPI:1881644946
Name:SLONIKER, MICHAEL LEROY (MS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEROY
Last Name:SLONIKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:L
Other - Last Name:SLONIKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2916 HAMILTON BLVD
Mailing Address - Street 2:LOWER C SUITE 103
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-258-3332
Mailing Address - Fax:712-258-3233
Practice Address - Street 1:2916 HAMILTON BLVD
Practice Address - Street 2:LOWER C SUITE 103
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-258-3332
Practice Address - Fax:712-258-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00357231H00000X
IA00592237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834592Medicaid
NE10025155400Medicaid
IA1443556Medicaid
SD5834592Medicaid