Healthcare Provider Details

I. General information

NPI: 1174678270
Provider Name (Legal Business Name): KRISTI MARIE SLATER ND, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 S KELLY AVE
PORTLAND OR
97239-3612
US

IV. Provider business mailing address

6114 S KELLY AVE
PORTLAND OR
97239-3612
US

V. Phone/Fax

Practice location:
  • Phone: 503-810-7471
  • Fax:
Mailing address:
  • Phone: 503-810-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number3094
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: