Healthcare Provider Details

I. General information

NPI: 1912254913
Provider Name (Legal Business Name): SLAUGHTER & SLAUGHTER THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 FREMONT AVE N STE 317
SEATTLE WA
98103-8811
US

IV. Provider business mailing address

3429 FREMONT AVE N STE 317
SEATTLE WA
98103-8811
US

V. Phone/Fax

Practice location:
  • Phone: 206-300-2452
  • Fax: 206-567-1212
Mailing address:
  • Phone: 206-300-2452
  • Fax: 206-567-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60075756
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60265736
License Number StateWA

VIII. Authorized Official

Name: SAMANTHA LEA SLAUGHTER
Title or Position: CEO
Credential:
Phone: 206-300-2452