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NPI Code Detail

MEDICARE: MISS HOPE D SLACK LMSW

MEDICARE: MISS HOPE D SLACK LMSW
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
1104100000XSocial Worker5711KS
21041C0700XClinical Social Worker3770

General Provider Information

NPI Number : 1447378427
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS HOPE D SLACK LMSW
Provider Business Mailing Address
First Line : 5815 BROADWAY
Second Line :
City : GREAT BEND
State : KS
Zip : 67530
Country : US
Telephone Number : 620-792-2544
Fax Number : 620-792-7052
Provider Business Practice Location Address
First Line : 5815 BROADWAY AVE
Second Line :
City : GREAT BEND
State : KS
Zip : 67530-3123
Country : US
Telephone Number : 620-792-2544
Fax Number : 620-792-7052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 11/26/2007

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Directions to “ MISS HOPE D SLACK LMSW” Practice Location

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