Healthcare Provider Details

I. General information

NPI: 1417161803
Provider Name (Legal Business Name): KENNETH SLATER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CONSTITUTION DR STE 10
BEDFORD NH
03110-6076
US

IV. Provider business mailing address

18 CONSTITUTION DR STE 10
BEDFORD NH
03110-6076
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number9025
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number9025
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: