Provider Demographics
NPI:1063138352
Name:SLAGOWSKI, TRAVIS JAY (BA, MA, LPC-2085)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JAY
Last Name:SLAGOWSKI
Suffix:
Gender:M
Credentials:BA, MA, LPC-2085
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ST STEPHENS
Mailing Address - State:WY
Mailing Address - Zip Code:82524-0190
Mailing Address - Country:US
Mailing Address - Phone:307-856-0470
Mailing Address - Fax:307-463-4477
Practice Address - Street 1:22 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510-8251
Practice Address - Country:US
Practice Address - Phone:307-856-0470
Practice Address - Fax:307-463-4254
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional