Provider Demographics
NPI:1861541807
Name:SLATICK, EMIL PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:EMIL
Middle Name:PAUL
Last Name:SLATICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SW COAST HWY
Mailing Address - Street 2:#202
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4988
Mailing Address - Country:US
Mailing Address - Phone:541-574-9801
Mailing Address - Fax:541-994-8022
Practice Address - Street 1:255 SW COAST HWY
Practice Address - Street 2:#202
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4988
Practice Address - Country:US
Practice Address - Phone:541-574-9801
Practice Address - Fax:541-994-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022452Medicaid