Basic Information
| Provider Information | |||||||||
| NPI: | 1063138352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLAGOWSKI | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | BA, MA, LPC-2085 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | ST STEPHENS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825240190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078560470 | ||||||||
| FaxNumber: | 3074634477 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 GREAT PLAINS ROAD | ||||||||
| Address2: | |||||||||
| City: | ARAPAHOE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825108251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078560470 | ||||||||
| FaxNumber: | 3074634254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-2085 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.