MEDICARE: DR. DOUGLAS SLAKEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	29851	CA

General Provider Information

NPI Number	:	1033595681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SLAKEY PHD

Provider Business Mailing Address
First Line	:	611 VETERANS BLVD STE 205
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1401
Country	:	US
Telephone Number	:	650-362-3505
Fax Number	:	650-362-3548

Provider Business Practice Location Address
First Line	:	611 VETERANS BLVD STE 205
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1401
Country	:	US
Telephone Number	:	650-362-3505
Fax Number	:	650-362-3548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	03/14/2020

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