Ethan Thomas Slabaugh, DNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN2361626 Issued in MA

Practice address

82 Wendell Ave Ste 100
Pittsfield, MA 01201-7066

Phone

(617) 517-6340

Fax

(423) 301-6604

NPI assigned

Aug 30, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Excelsior Psychological Services, PLC

  • Cognitive & Behavioral Psychologist
  • Utica, MI
  • NPI 1326441809
  Medicare reassignment NPD
• Wolverine Healthcare LLC

  • Nurse Practitioner
  • Pittsfield, MA
  • NPI 1043015837
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1134849326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 WENDELL AVE STE 100",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012017066",
            "telephone_number": "617-517-6340",
            "fax_number": "423-301-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 WENDELL AVE STE 100",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012017066",
            "telephone_number": "617-517-6340",
            "fax_number": "423-301-6604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Boston Post Rd",
            "address_purpose": "LOCATION",
            "city": "Sudbury",
            "state": "MA",
            "postal_code": "017763335",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLABAUGH",
        "first_name": "ETHAN",
        "middle_name": "THOMAS",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-30",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2361626",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2361626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Ann Sirard, SLP
• Sisu Psychotherapy
• Jason Skalski
• Aurielle Skidmore
• Steven Alan Skoblow, LMHC
• Candace Slack
• Aaron Slater
• April Elizabeth Slater, LICSW
• Lauren Beth Slater, M.D.
• Michelle Lee Slatergoggia

• Nurse Practitioner in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.