Provider Demographics
NPI:1730369893
Name:SLATER, KIMBERLY KEYON
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KEYON
Last Name:SLATER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:KEYON
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:901 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1106
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:
Practice Address - Street 1:901 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1106
Practice Address - Country:US
Practice Address - Phone:256-492-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker