Individual
ASHLEY JESSICA SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(301) 580-3034
Mailing address
3305 WATERFORD MILL RD, BOWIE, MD 20721-3280
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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