Individual
STEVEN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4512 NE PORTLAND HWY, PORTLAND, OR 97218-1363
(503) 935-1513
Mailing address
4512 NE PORTLAND HWY, PORTLAND, OR 97218-1363
(503) 935-1513
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW1630
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW1630
PEER SUPPORT SPECIALIST
OR
05
—
THW1630
—
OR
Enumeration date
03/27/2018
Last updated
06/16/2018
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