Provider Demographics
NPI:1386197796
Name:SLOMINSKI, TESSA (LCSW)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:SLOMINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:905 KERMIT CT
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9764
Mailing Address - Country:US
Mailing Address - Phone:937-241-6682
Mailing Address - Fax:
Practice Address - Street 1:905 KERMIT CT
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9764
Practice Address - Country:US
Practice Address - Phone:937-241-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-133061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical