Healthcare Provider Details

I. General information

NPI: 1154235224
Provider Name (Legal Business Name): HALEY SLADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 31ST ST
DOWNERS GROVE IL
60515-1235
US

IV. Provider business mailing address

738 N MORGAN ST APT 1106
CHICAGO IL
60642-6597
US

V. Phone/Fax

Practice location:
  • Phone: 630-515-6034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: