Individual
DR. WADE W JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
603 EUGENIA DRIVE, MEDFORD, NJ 08055-2311
(609) 654-4455
Mailing address
PO BOX 1331, MEDFORD, NJ 08055-6331
(609) 654-4455
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35SI00157000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1728806
—
NJ
Enumeration date
05/22/2007
Last updated
07/08/2007
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