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General NPI Number Information
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NPI Number | 1114943016
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Entity Type | Individual
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Provider Name | WILLIAM RICHARD SLAGLE PHD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1070 WIGWAM PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89074-8178
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Country | US
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Telephone | 702-454-0201
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Fax | 702-454-1245
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Provider Business Mailing Address
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Address Line | 1070 WIGWAM PKWY STE 10
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City | HENDERSON
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State | NV
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Zip | 89074-8177
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Country | US
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Telephone | 702-454-0201
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Fax | 702-454-1245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0456
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License Number State | NV
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