Healthcare Provider Details

I. General information

NPI: 1619123916
Provider Name (Legal Business Name): KATRINA SLIWKA LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GRANDVIEW AVE
ESSEX JUNCTION VT
05452-3008
US

IV. Provider business mailing address

23 GRANDVIEW AVE
ESSEX JUNCTION VT
05452-3008
US

V. Phone/Fax

Practice location:
  • Phone: 802-310-5675
  • Fax:
Mailing address:
  • Phone: 802-310-5675
  • Fax: 802-488-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000746
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: