MEDICARE: ANN ELISABETH SLEN

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000	OTHER	IN	INDIANA FIRST STEPS

General Provider Information

NPI Number	:	1447804109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN ELISABETH SLEN

Provider Business Mailing Address
First Line	:	1913 OMEE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7961
Country	:	US
Telephone Number	:	260-348-7645
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 OMEE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7961
Country	:	US
Telephone Number	:	260-348-7645
Fax Number	:

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

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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