Basic Information
| Provider Information | |||||||||
| NPI: | 1497888580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLAISE | ||||||||
| FirstName: | DEANN | ||||||||
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| Credential: | MSW, PPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1549 W 104TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900474523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108787177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900373527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237512677 | ||||||||
| FaxNumber: | 3237528547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 11/22/2017 | ||||||||
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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 | 1041C0700X | 80380 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.