Healthcare Provider Details

I. General information

NPI: 1104011170
Provider Name (Legal Business Name): ANNA M SLAWNY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 8TH AVE
KENOSHA WI
53140-3700
US

IV. Provider business mailing address

3248 S WOLLMER RD APT C
WEST ALLIS WI
53227-4704
US

V. Phone/Fax

Practice location:
  • Phone: 262-564-0067
  • Fax: 262-652-1411
Mailing address:
  • Phone: 262-564-0067
  • Fax: 262-652-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: