MEDICARE: FREDERICK SLATE ED.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	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1932391489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK SLATE ED.D.

Provider Business Mailing Address
First Line	:	1048 VICTORIA LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4508
Country	:	US
Telephone Number	:	630-469-5781
Fax Number	:	630-469-5781

Provider Business Practice Location Address
First Line	:	1048 VICTORIA LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4508
Country	:	US
Telephone Number	:	630-469-5781
Fax Number	:	630-469-5781

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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