| Doctor Name: | DR. MICHAEL BYRON SLACK |
| NPI Number: | 1104939222 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D |
| License Number: | LSCSW1952 |
| Business Practice Address: | 101 Bodin Cir David Grant Medical Center Travis Afb, CA - 945351809 |
| Business Phone Number: | 7074233811 |
| Business Fax Number: | |
| Mailing Address: | 101 Bodin Cir, David Grant Medical Center TRAVIS AFB |
| State: | CA |
| Postal Code: | 945351809 |
| Phone Number: | 7074233811 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LSCSW1952 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |