Healthcare Provider Details

I. General information

NPI: 1174842264
Provider Name (Legal Business Name): BONNIE SLATER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7047 E GREENWAY PKWY STE 250
SCOTTSDALE AZ
85254-8113
US

IV. Provider business mailing address

7047 E GREENWAY PKWY STE 250
SCOTTSDALE AZ
85254-8113
US

V. Phone/Fax

Practice location:
  • Phone: 480-322-0278
  • Fax: 602-870-7472
Mailing address:
  • Phone: 480-322-0278
  • Fax: 602-870-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC11789
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number2281558
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: