=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124353156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN L SLOAN, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2009
-----------------------------------------------------
Last Update Date | 11/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4731 84TH AVE SE
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-375-2774
-----------------------------------------------------
Fax | 206-829-9410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4731 84TH AVE SE
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-375-2774
-----------------------------------------------------
Fax | 206-829-9410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DR. KEVIN LAWRENCE SLOAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-829-9137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD00029132
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------