Provider Demographics
NPI:1124196951
Name:SLADE, SUE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANNE
Last Name:SLADE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15418 MAIN STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7361
Mailing Address - Country:US
Mailing Address - Phone:425-385-3262
Mailing Address - Fax:425-357-0924
Practice Address - Street 1:15418 MAIN STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7361
Practice Address - Country:US
Practice Address - Phone:425-385-3262
Practice Address - Fax:425-357-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7053416Medicaid