Provider Demographics
NPI:1720414907
Name:SLATE, CALLIE OLEDTA
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:OLEDTA
Last Name:SLATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S MONACO PKWY
Mailing Address - Street 2:APT. 111
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 S MONACO PKWY
Practice Address - Street 2:APT. 111
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1878
Practice Address - Country:US
Practice Address - Phone:479-414-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health