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General NPI Number Information
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NPI Number | 1245811397
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Entity Type | Individual
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Provider Name | KRISTIN JO SLAGTER
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 1550 WILLMAR AVE SE STE B
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City | WILLMAR
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State | MN
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Zip | 56201-4738
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Country | US
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Telephone | 320-235-6320
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Fax | 320-235-2542
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Provider Business Mailing Address
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Address Line | 1550 WILLMAR AVE SE STE B
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City | WILLMAR
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State | MN
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Zip | 56201-4738
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Country | US
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Telephone | 320-235-6320
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Fax | 320-235-2542
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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