Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013546233 |
---|---|
Provider Name | Ms. Jacqueline Marie Slade |
First Address | Las Vegas, NV 89129-4537 |
Second Address | Las Vegas, NV 89121-5074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |