=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174842264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BONNIE SLATER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2010
-----------------------------------------------------
Last Update Date | 10/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7047 E GREENWAY PKWY STE 250
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-8113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-322-0278
-----------------------------------------------------
Fax | 602-870-7472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7047 E GREENWAY PKWY STE 250
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-8113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-322-0278
-----------------------------------------------------
Fax | 602-870-7472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2055X
-----------------------------------------------------
Taxonomy Name | Child Mental Illness Respite Care
-----------------------------------------------------
License Number | 2281558
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC11789
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------