Provider Demographics
NPI:1306046396
Name:SLATER, MARION A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:A
Last Name:SLATER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MARION
Other - Middle Name:A
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 WEST 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762
Mailing Address - Country:US
Mailing Address - Phone:907-443-4503
Mailing Address - Fax:
Practice Address - Street 1:306 WEST 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK285OtherLMSW