Provider Demographics
NPI:1417637661
Name:SLADE ROFF TALK WELLNESS
Entity Type:Organization
Organization Name:SLADE ROFF TALK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:MAGENTA
Authorized Official - Last Name:ROFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-515-6695
Mailing Address - Street 1:200 LOCUST ST APT 25H
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-0118
Mailing Address - Country:US
Mailing Address - Phone:215-515-6695
Mailing Address - Fax:
Practice Address - Street 1:200 LOCUST ST APT 25H
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-0118
Practice Address - Country:US
Practice Address - Phone:215-515-6695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health