Individual
KISHA SLATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDEPENDENT PROVIDER
Contact information
Practice address
519 W DELAWARE AVE, TOLEDO, OH 43610-1310
(419) 277-0559
Mailing address
519 W DELAWARE AVE, TOLEDO, OH 43610-1310
(419) 277-0559
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
RS619850
OH
347C00000X
Private Vehicle
Primary
RS619850
OH
376J00000X
Homemaker
—
—
Other
Enumeration date
09/25/2020
Last updated
10/11/2022
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