Healthcare Provider Details

I. General information

NPI: 1104030683
Provider Name (Legal Business Name): STANLEY BERNARD SLOAN FOADP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 W GRAND BLVD
DETROIT MI
48208-1105
US

IV. Provider business mailing address

15743 FORRER ST
DETROIT MI
48227-2332
US

V. Phone/Fax

Practice location:
  • Phone: 313-895-0500
  • Fax: 313-895-9503
Mailing address:
  • Phone: 313-272-4845
  • Fax: 313-895-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: