Provider Demographics
NPI:1447685177
Name:SLADE, AUSTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:SLADE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4079 GOVERNOR DR # 225
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2522
Mailing Address - Country:US
Mailing Address - Phone:858-442-0708
Mailing Address - Fax:
Practice Address - Street 1:3660 CLAIREMONT DR STE 9
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5969
Practice Address - Country:US
Practice Address - Phone:858-442-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist