Provider Demographics
NPI:1679641120
Name:SLOTKY, WILL (MSW)
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:SLOTKY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HICKORY MNR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2797
Mailing Address - Country:US
Mailing Address - Phone:314-361-4673
Mailing Address - Fax:314-361-6649
Practice Address - Street 1:4507 LACLEDE AVE # B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2103
Practice Address - Country:US
Practice Address - Phone:314-361-4673
Practice Address - Fax:314-361-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005034101YM0800X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA836148OtherVALUE OPTIONS PROVIDER ID