Provider Demographics
NPI:1215286471
Name:SLAYTON, SANDRA (MS, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W SPRINGFIELD AVE
Mailing Address - Street 2:1005
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6385
Mailing Address - Country:US
Mailing Address - Phone:217-693-4918
Mailing Address - Fax:217-531-4071
Practice Address - Street 1:201 W SPRINGFIELD AVE
Practice Address - Street 2:1005
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6385
Practice Address - Country:US
Practice Address - Phone:217-693-4918
Practice Address - Fax:217-531-4071
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
IL178010752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor