=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114019577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON SLATON MA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12607 SE MILL PLAIN BLVD
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-6055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-891-6273
-----------------------------------------------------
Fax | 360-896-4478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23105 NE 237TH CT
-----------------------------------------------------
City | BATTLE GROUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98604-3978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-687-2722
-----------------------------------------------------
Fax | 360-896-4478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP00005315
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------