Individual
DENISE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
185 GENESEE ST, UTICA, NY 13501-2102
(315) 798-5249
(315) 731-3491
Mailing address
185 GENESEE ST, UTICA, NY 13501-2102
(315) 798-5249
(315) 731-3491
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0474268
—
NY
Enumeration date
10/21/2015
Last updated
10/21/2015
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