MEDICARE: DR. HOWARD RYAN SLUTZKY PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2431	NC

General Provider Information

NPI Number	:	1063465078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD RYAN SLUTZKY PSYD

Provider Business Mailing Address
First Line	:	12603 WINDYEDGE RD
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-2243
Country	:	US
Telephone Number	:	704-895-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	18121 W CATAWBA AVE
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5641
Country	:	US
Telephone Number	:	704-895-0085
Fax Number	:	704-895-2585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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