Healthcare Provider Details

I. General information

NPI: 1598669699
Provider Name (Legal Business Name): TELICIA SLADE LPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 29 1/2 RD
GRAND JUNCTION CO
81504-5201
US

IV. Provider business mailing address

633 29 1/2 RD
GRAND JUNCTION CO
81504-5201
US

V. Phone/Fax

Practice location:
  • Phone: 970-361-1335
  • Fax:
Mailing address:
  • Phone: 970-361-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0001636
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: