Individual
JOHN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA, MA OF ED. L.
Contact information
Practice address
4785 W. GRANT RD., SHELBY, MI 49455
(231) 724-0382
Mailing address
4785 W. GRANT RD., SHELBY, MI 49455
(231) 742-0382
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000424
MI
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003914946
—
MI
01
—
7401000424
BEHAVIORAL ANALYST LICENSE
MI
Enumeration date
05/26/2017
Last updated
06/23/2022
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