Healthcare Provider Details

I. General information

NPI: 1356443311
Provider Name (Legal Business Name): THERESA KIM SLAUGHTER DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 HIGHLAND DR
PITTSBURGH PA
15206-1206
US

IV. Provider business mailing address

427 FORD ST
WEST MIFFLIN PA
15122-4105
US

V. Phone/Fax

Practice location:
  • Phone: 412-365-5285
  • Fax:
Mailing address:
  • Phone: 412-469-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number818268
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: