MEDICARE: NICOLE C SLATTENGREN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1063798155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE C SLATTENGREN

Provider Business Mailing Address
First Line	:	1613 TROPICAL DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-5349
Country	:	US
Telephone Number	:	218-348-0798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 TROPICAL DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-5349
Country	:	US
Telephone Number	:	218-348-0798
Fax Number	:

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “ NICOLE C SLATTENGREN ” Practice Location

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