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General NPI Number Information
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NPI Number | 1811344450
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Entity Type | Individual
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Provider Name | ROGER MILTON SLAGLE MFA LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 999 MISSION DE ORO DR STE 103
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City | REDDING
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State | CA
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Zip | 96003
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Country | US
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Telephone | 530-605-0189
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Fax | 530-605-4428
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Provider Business Mailing Address
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Address Line | 8570 SAVANNAH WAY
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City | SHINGLETOWN
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State | CA
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Zip | 96088-9308
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Country | US
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Telephone | 530-646-7778
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW10885
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License Number State | CA
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