Provider Demographics
NPI:1992581235
Name:SLOAN PSYCHIATRIC CARE PLLC
Entity type:Organization
Organization Name:SLOAN PSYCHIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:208-944-1537
Mailing Address - Street 1:1006 VANDERDASSON RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-8880
Mailing Address - Country:US
Mailing Address - Phone:208-944-1537
Mailing Address - Fax:208-944-6067
Practice Address - Street 1:1006 VANDERDASSON RD
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-8880
Practice Address - Country:US
Practice Address - Phone:509-731-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty