Provider Demographics
NPI:1003523226
Name:SLEDGE, TALIA W (LMSW)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:W
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 TRELLIS DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2974
Mailing Address - Country:US
Mailing Address - Phone:505-850-3502
Mailing Address - Fax:
Practice Address - Street 1:1122 CENTRAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2947
Practice Address - Country:US
Practice Address - Phone:505-850-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 251V00000X, 376J00000X, 390200000X, 104100000X
NMSWB-2023-13441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251V00000XAgenciesVoluntary or Charitable
No376J00000XNursing Service Related ProvidersHomemaker