Provider Demographics
NPI:1174176127
Name:SLAGLE, DAVID A (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 NE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2700
Mailing Address - Country:US
Mailing Address - Phone:206-271-1131
Mailing Address - Fax:
Practice Address - Street 1:1424 NE 155TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7104
Practice Address - Country:US
Practice Address - Phone:206-271-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist