Provider Demographics
NPI:1922089309
Name:SALLADE, TAMI SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:SUE
Last Name:SALLADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TAMI
Other - Middle Name:SUE
Other - Last Name:SPETNAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3028 ROSEDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1810
Mailing Address - Country:US
Mailing Address - Phone:502-454-7329
Mailing Address - Fax:502-633-3634
Practice Address - Street 1:12700 SHELBYVILLE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1576
Practice Address - Country:US
Practice Address - Phone:502-254-8880
Practice Address - Fax:502-633-3634
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0928503Medicare ID - Type Unspecified