=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801482336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL SLATER NORTH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2020
-----------------------------------------------------
Last Update Date | 12/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2950 PROFESSIONAL PL STE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80904-8106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-667-1327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2610 GRAND VISTA CIR APT 109
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80904-5246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-808-6957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD.0001053
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------