Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 949 | WI |
NPI | 1003827163 |
---|---|
Provider Name | Karen Slattery |
First Address | Wausau, WI 54403-6785 |
Second Address | Wausau, WI 54403-6785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
949-132 | STATE LICENSE (01) | WI |