Individual
MR. RANDALL LEE SLAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
151 S 4TH ST, SUITE 401, GRAND FORKS, ND 58201-4715
(701) 795-3000
(701) 795-3050
Mailing address
151 S 4TH ST, SUITE 401, GRAND FORKS, ND 58201-4715
(701) 795-3000
(701) 795-3050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1959
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020530
BCBS ND PROVIDER NUMBER
ND
05
—
054519
—
ND
01
—
73B47SL
BCBS MN PROVIDER NUMBER
MN
Enumeration date
06/11/2006
Last updated
07/09/2007
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