MEDICARE: MRS. KRISTEN LYNN SLATER LCSW

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	1041C0700X	Clinical Social Worker	25454	CA

General Provider Information

NPI Number	:	1346332442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN LYNN SLATER LCSW

Provider Business Mailing Address
First Line	:	5015 BIRCH ST STE 115
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-8113
Country	:	US
Telephone Number	:	714-319-8041
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 BIRCH ST STE 115
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-8113
Country	:	US
Telephone Number	:	714-319-8041
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/27/2013

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