Individual
STEPHEN DANIEL SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
458 W 61ST ST, SHREVEPORT, LA 71106-2511
(318) 510-1141
Mailing address
458 W 61ST ST, SHREVEPORT, LA 71106-2511
(318) 510-1141
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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