Healthcare Provider Details

I. General information

NPI: 1174476378
Provider Name (Legal Business Name): MARY SLATER, MA-SLPCCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 INTERLACHEN DR APT 919
SILVER SPRING MD
20906-5634
US

IV. Provider business mailing address

15107 INTERLACHEN DR APT 919
SILVER SPRING MD
20906-5634
US

V. Phone/Fax

Practice location:
  • Phone: 301-642-4993
  • Fax:
Mailing address:
  • Phone: 301-642-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY SLATER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 301-642-4993