Individual
ALICIA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
420 W GRAND AVE, LAKE VILLA, IL 60031
(847) 356-3322
Mailing address
PO BOX 1088, LAKE VILLA, IL 60046-1088
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149019700
IL
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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