Organization
WADE PSYCHOLOGICAL SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEFANIE WADE PSYD, HSPP (OWNER)
(574) 534-2161
Entity
Organization
Contact information
Practice address
1930 W LINCOLN AVE, GOSHEN, IN 46526-5907
(574) 534-2161
(574) 534-3887
Mailing address
1930 W LINCOLN AVE, GOSHEN, IN 46526-5907
(574) 534-2161
(574) 534-3887
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042314A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200938090A
—
IN
Enumeration date
07/26/2010
Last updated
07/26/2010
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