Individual
DR. KELLY JENSEN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4830 SOUTHPOINT DR, FREDERICKSBURG, VA 22407-2606
(540) 370-4468
Mailing address
130 EXECUTIVE CENTER PKWY, FREDERICKSBURG, VA 22401-3100
(540) 699-4969
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810006297
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-2331951
TAX ID#
CO
Enumeration date
08/18/2011
Last updated
04/08/2024
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