Individual
JOHN E WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1956 E WHIPP RD, KETTERING, OH 45440-2921
(937) 433-5957
(937) 281-0562
Mailing address
1956 E WHIPP RD, KETTERING, OH 45440-2921
(937) 384-3896
(937) 281-0562
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5936
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000617539
ANTHEM
OH
05
—
2544689
—
OH
01
—
311175717273
CARESOURCE
—
01
—
5936
OHIO LICENSE
OH
Enumeration date
01/22/2007
Last updated
11/16/2020
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