Provider Demographics
NPI:1992528319
Name:SLADE, JAKKIM
Entity type:Individual
Prefix:
First Name:JAKKIM
Middle Name:
Last Name:SLADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 E DESERT INN RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3690
Mailing Address - Country:US
Mailing Address - Phone:702-490-9009
Mailing Address - Fax:866-737-9147
Practice Address - Street 1:2755 E DESERT INN RD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3690
Practice Address - Country:US
Practice Address - Phone:702-490-9009
Practice Address - Fax:866-737-9147
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician