Individual
DR. JACQUELINE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD LCSW
Contact information
Practice address
2620 REGATTA DR STE 102, LAS VEGAS, NV 89128-6892
(702) 751-2408
Mailing address
2620 REGATTA DR STE 102, LAS VEGAS, NV 89128-6892
(702) 751-2408
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2531-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134549041
—
NV
Enumeration date
04/17/2014
Last updated
03/01/2021
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