Healthcare Provider Details

I. General information

NPI: 1710128129
Provider Name (Legal Business Name): LESLEY ANN SLAVIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 KILAUEA AVE ROOM 405
HONOLULU HI
96816-2317
US

IV. Provider business mailing address

3627 KILAUEA AVE ROOM 405
HONOLULU HI
96816-2317
US

V. Phone/Fax

Practice location:
  • Phone: 808-733-9358
  • Fax: 808-733-9875
Mailing address:
  • Phone: 808-733-9358
  • Fax: 808-733-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number864
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: