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Individual

MADELINE SLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
104 N MAIN ST, MARYSVILLE, OH 43040-1106
(937) 537-5100
Mailing address
446 MORGAN ST, CINCINNATI, OH 45206-2348
(513) 834-7063
(513) 873-1567

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E.2001693-SUPV
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0266106
OH
Enumeration date
09/28/2017
Last updated
03/17/2024
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