=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467624742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA G SLOCUM MSW LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2008
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 S MAIN ST SUITE B
-----------------------------------------------------
City | SUGAR GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-992-5646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1123 76 S MAIN ST SUITE B
-----------------------------------------------------
City | SUGAR GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-992-5646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | CYNTHIA G SLOCUM
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 630-992-5646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------