Provider Demographics
NPI:1912293903
Name:SLATER, KIM GRIGGS (LCPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:GRIGGS
Last Name:SLATER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 WYDOWN LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4447
Mailing Address - Country:US
Mailing Address - Phone:630-375-0632
Mailing Address - Fax:
Practice Address - Street 1:2569 WYDOWN LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-4447
Practice Address - Country:US
Practice Address - Phone:630-375-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health