MEDICARE: DR. JOHN PATRICK SLATTERY PH.D.

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	PY00002106	WA

General Provider Information

NPI Number	:	1790997039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK SLATTERY PH.D.

Provider Business Mailing Address
First Line	:	2517 EASTLAKE AVE E
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98102-3278
Country	:	US
Telephone Number	:	206-328-0910
Fax Number	:	206-328-2310

Provider Business Practice Location Address
First Line	:	2517 EASTLAKE AVE E
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98102-3278
Country	:	US
Telephone Number	:	206-328-0910
Fax Number	:	206-328-2310

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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