MEDICARE: SUSAN FEDER SLOBARD M.D.

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	2084P0800X	Psychiatry Physician	1573581	NY
2	2084P0804X	Child & Adolescent Psychiatry Physician	1573581	NY
3	2084P0800X	Psychiatry Physician	ME102673	FL
4	2084P0804X	Child & Adolescent Psychiatry Physician	ME102673	FL
5	2084P0804X	Child & Adolescent Psychiatry Physician	036068243	IL

General Provider Information

NPI Number	:	1639230303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FEDER SLOBARD M.D.

Provider Business Mailing Address
First Line	:	1021 N MULFORD RD
Second Line	:	STE 1
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-399-9700
Fax Number	:	815-394-1401

Provider Business Practice Location Address
First Line	:	1021 N MULFORD RD
Second Line	:	STE 1
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-399-9700
Fax Number	:	815-394-1401

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/30/2012

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Directions to “ SUSAN FEDER SLOBARD M.D.” Practice Location

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