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General NPI Number Information
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NPI Number | 1639230303
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Entity Type | Individual
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Provider Name | SUSAN FEDER SLOBARD M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 1021 N MULFORD RD STE 1
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City | ROCKFORD
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State | IL
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Zip | 61107-3877
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Country | US
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Telephone | 815-399-9700
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Fax | 815-394-1401
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Provider Business Mailing Address
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Address Line | 1021 N MULFORD RD STE 1
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City | ROCKFORD
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State | IL
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Zip | 61107-3877
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Country | US
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Telephone | 815-399-9700
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Fax | 815-394-1401
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1573581
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 1573581
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME102673
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME102673
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036068243
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License Number State | IL
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