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General NPI Number Information
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NPI Number | 1013546233
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE SLADE M.ED
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 4180 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89121-5074
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Country | US
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Telephone | 702-486-7500
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Fax | 702-486-7576
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Provider Business Mailing Address
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Address Line | 10352 BOONE HILLS CT
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City | LAS VEGAS
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State | NV
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Zip | 89129-4537
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Country | US
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Telephone | 702-204-7312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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