Healthcare Provider Details

I. General information

NPI: 1104501782
Provider Name (Legal Business Name): JANESSIA NANI SLAUGHTER MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-4249
  • Fax: 314-454-2557
Mailing address:
  • Phone: 314-454-4249
  • Fax: 314-454-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2023008697
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: