Provider Demographics
NPI:1093458515
Name:SLADER, JILL KATHRYN (MACP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:KATHRYN
Last Name:SLADER
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KATHRYN
Other - Last Name:SLADER-YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1109 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4319
Practice Address - Country:US
Practice Address - Phone:302-562-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty