MEDICARE: MR. TRAVIS R SLONE LCSW

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	164X00000X	Licensed Vocational Nurse	188448	TX
2	1041C0700X	Clinical Social Worker	C009462	NC

General Provider Information

NPI Number	:	1932281839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS R SLONE LCSW

Provider Business Mailing Address
First Line	:	786 D ST
Second Line	:
City	:	FORT RICHARDSON
State	:	AK
Zip	:	99505-1023
Country	:	US
Telephone Number	:	907-384-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	786 D ST
Second Line	:
City	:	FORT RICHARDSON
State	:	AK
Zip	:	99505-1023
Country	:	US
Telephone Number	:	907-384-0405
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/24/2025

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