Doctor Name: | JESSICA MARIE SLACK |
NPI Number: | 1023489770 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLMSW |
License Number: | 6801098796 |
Business Practice Address: | 114 Orchard Lake Road Pontiac, MI - 48341 |
Business Phone Number: | 2488587766 |
Business Fax Number: | 2488587201 |
Mailing Address: | G3230 Hogarth Avenue, FLINT |
State: | MI |
Postal Code: | 48532 |
Phone Number: | 8104297359 |
Fax Number: | |
NPI Enumeration Date: | 10/07/2015 |
NPI Last Update Date: | 12/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801098796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |