Basic Information
| Provider Information | |||||||||
| NPI: | 1922139617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLOVICK | ||||||||
| FirstName: | LAURENE | ||||||||
| MiddleName: | LADENA | ||||||||
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| Credential: | CADCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14322 SE LAURIE AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972671043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032806646 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9111 NE SUNDERLAND RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972111708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032806646 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | X | Behavioral Health & Social Service Providers | Counselor |
No ID Information.