Provider Demographics
NPI:1427265107
Name:SLIM-SYLLING, IVONNE MARGARITA
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARGARITA
Last Name:SLIM-SYLLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-4107
Mailing Address - Country:US
Mailing Address - Phone:805-614-1372
Mailing Address - Fax:805-614-1571
Practice Address - Street 1:1410 S BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6971
Practice Address - Country:US
Practice Address - Phone:805-614-1372
Practice Address - Fax:805-614-1571
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health