Individual
ANN SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Mailing address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 843-6130
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4923-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1773-26
STATE OCCUPATIONAL THERAPY LICENSE
WI
Enumeration date
12/02/2021
Last updated
12/02/2021
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