Healthcare Provider Details

I. General information

NPI: 1225958044
Provider Name (Legal Business Name): JOLIE M SLATER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N LAKE AVE STE 600
PASADENA CA
91101-5129
US

IV. Provider business mailing address

301 N LAKE AVE STE 600
PASADENA CA
91101-5129
US

V. Phone/Fax

Practice location:
  • Phone: 626-344-0264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94029647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: