Healthcare Provider Details

I. General information

NPI: 1306001722
Provider Name (Legal Business Name): MRS. LINDA MARIE SLATER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 PAPAL DR
FLORISSANT MO
63033-7012
US

IV. Provider business mailing address

4358 PAPAL DR
FLORISSANT MO
63033-7012
US

V. Phone/Fax

Practice location:
  • Phone: 314-369-6211
  • Fax: 314-839-5914
Mailing address:
  • Phone: 314-369-6211
  • Fax: 314-839-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number172V00000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: