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General NPI Number Information
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NPI Number | 1770661100
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Entity Type | Individual
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Provider Name | JAMES CHARLES SLATTERY LSW CDCA
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 405 TALLMADGE RD
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221-3362
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Country | US
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Telephone | 330-907-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 PINEBROOK TRL
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44223-2587
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Country | US
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Telephone | 330-945-4046
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S31088
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 071019
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License Number State | OH
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