Healthcare Provider Details

I. General information

NPI: 1114943016
Provider Name (Legal Business Name): WILLIAM RICHARD SLAGLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 WIGWAM PKWY STE 100
HENDERSON NV
89074-8178
US

IV. Provider business mailing address

1070 WIGWAM PKWY STE 10
HENDERSON NV
89074-8177
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-0201
  • Fax: 702-454-1245
Mailing address:
  • Phone: 702-454-0201
  • Fax: 702-454-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0456
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: