Basic Information
| Provider Information | |||||||||
| NPI: | 1235471053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOVAK | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | SUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25446 RAMBLEHURST DR | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435516721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 W SOUTH BOUNDARY ST | ||||||||
| Address2: | BUILDING 2, SUITE B | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I.1201390 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.