Healthcare Provider Details

I. General information

NPI: 1114329026
Provider Name (Legal Business Name): LESLIE SLIPAKOFF R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST
DENVER CO
80220-3808
US

IV. Provider business mailing address

238 CATHARINE ST #3
PHILADELPHIA PA
19147-3303
US

V. Phone/Fax

Practice location:
  • Phone: 970-948-8107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number520657
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: