Provider Demographics
NPI:1730779596
Name:SLADE, KAILYN R (LCSW)
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:R
Last Name:SLADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12569 PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2349
Mailing Address - Country:US
Mailing Address - Phone:703-220-0037
Mailing Address - Fax:
Practice Address - Street 1:12569 PLYMOUTH CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2349
Practice Address - Country:US
Practice Address - Phone:703-220-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06091081041S0200X
VA09040125951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical