Provider Demographics
NPI:1962051185
Name:SLATER, SUSAN M (EDD- DR OF EDUCATION)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SLATER
Suffix:
Gender:F
Credentials:EDD- DR OF EDUCATION
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:PEDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25964 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2188
Mailing Address - Country:US
Mailing Address - Phone:612-280-5382
Mailing Address - Fax:
Practice Address - Street 1:25964 COUNTY ROAD 4
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2188
Practice Address - Country:US
Practice Address - Phone:612-280-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider